Transcarotid Artery Revascularization (TCAR)

Minimally invasive approach to prevent stroke in patients that need carotid intervention

Catawba Valley Health System is pioneering the use of a breakthrough technology called Transcarotid Artery Revascularization (TCAR) to treat patients with carotid artery disease who are at risk for open surgery. While any repair of the carotid artery carries some risk of causing a stroke because of the repair itself, TCAR was designed to help minimize that risk by keeping potential stroke causing fragments away from the brain.

Like the open surgery, carotid endarterectomy (CEA), this new procedure involves direct access to the carotid artery, but through a much smaller incision at the neckline just above the clavicle instead of a longer incision on the neck. During the TCAR procedure, a tube inserted into the carotid artery is connected to a system that temporarily directs blood flow away from the brain to protect against dangerous debris from reaching the brain during the procedure. Surgeons then filter the blood before returning it to a vein in the groin, and a stent is implanted directly into the carotid artery to stabilize the plaque and prevent future strokes. The entire procedure is performed in less than half the time of CEA – limiting the stress on the heart and significantly cutting the risk of the patient having a stroke or heart attack during the procedure.

Patients who undergo the TCAR procedure recover quickly (typically spending just one night in the hospital) and almost always go home the next day to return to full and productive lives with less pain, smaller scars and a reduced risk of future strokes.

Your physician may recommend the TCAR procedure if you’ve been diagnosed with carotid artery disease and are not a suitable candidate for CEA. This may depend on your age or other existing medical conditions. For more information about TCAR, call us at 828.732.5200 to schedule a consultation with one of our vascular surgeons.

Dr. Gener Augustin TCAR Dr. Gener Dressler is one of only a few vascular surgeons in North Carolina to be specially trained in TCAR procedures.

Frequently Asked Questions

What is TransCarotid Artery Revascularization or TCAR?

TCAR has been clinically proven as a less-invasive alternative to carotid endarterectomy, a traditional open surgery performed to treat carotid artery disease. What’s unique about TCAR is it temporarily reverses the blood flow during the procedure, so that any small bits of plaque that may break off during the procedure are diverted away from the brain, preventing a stroke from happening. A stent is then placed inside the artery to stabilize the plaque, minimizing the risk of a future stroke.

How is TCAR better for patients?

TCAR has a very low procedural stroke rate. It is also less invasive than open surgery, so there’s less chance for surgical complications like heart attacks, infection and nerve injury. TCAR patients also recover quickly and almost always go home the next day with less pain and smaller scars.

How safe is TCAR?

Over 5,000 TCAR procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent. In fact, the data are so compelling that the Society of Vascular Surgeons, Centers for Medicare and Medicaid Services (CMS), and the U.S. Food and Drug Administration (FDA) came together in September 2016 to create a program to support its reimbursement.

Who should be considered for the TCAR procedure?

TCAR is recommended for patients who are considered high risk for traditional surgery due to age, anatomic issues and other medical conditions. A physician will determine if the TCAR procedure is right for a patient on a case-by-case basis based on his/her medical history and workup.

What happens during a TCAR procedure?

A small incision is made at the base of the neck, just above the collarbone. A puncture is made into the carotid artery and a small tube is placed inside the artery, which is connected to the system that temporarily directs blood flow away from the brain and captures any dangerous debris that dislodges from the artery. The blood is then filtered and returned to a vein through a second tube placed in the groin. While the brain is protected during this temporary flow reversal, a stent is placed in the carotid artery to stabilize the plaque and is intended to help prevent against future stroke. The blood flow is then returned to normal and the system is removed.

The entire procedure usually takes less than an hour. Patients can be either asleep or awake during the TCAR procedure and patients are typically held overnight for observation.

Is it ever a problem that the blood is being diverted away from the brain?

It’s rarely a problem because the brain has multiple arteries that supply it with blood. In addition, the critical part of the procedure, when the blood flow is reversed, only lasts about 10 minutes.

Who invented TCAR?

Vascular surgeons Dr. David Chang and Dr. Enrique Criado came up with the idea separately, but around the same time in 2004. Silk Road Medical, Inc. based in California has worked over the past 10+ years with the vascular surgery community in refining the procedure, conducting clinical trials, and are now commercializing TCAR in the U.S.

For more information about the TCAR procedure and essential prescribing information, please visit http://silkroadmed.com/ifus/. For more information about carotid artery disease and the risks involved with any intervention (e.g. bleeding, death, myocardial infarction, restenosis, stroke, TIA, vessel dissection, vessel occlusion, etc.) please visit http://silkroadmed.com/disease-and-treatment-options/.