Health Watch: New procedure removes blockages in carotid artery

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TransCarotid Artery Revascularization (TCAR) is an innovative new procedure that reduces the risk of stroke while clearing blockages in patient's carotid arteries.  TCAR also provides faster recovery times than traditional methods.

Every year, 15 million people worldwide suffer from stroke. Six million people die and five million are permanently disabled from stroke. Up to one-third of the cases predict carotid artery disease to be the source of stroke and there are 400,000 new diagnoses of carotid artery disease made every year in the U.S.

TransCarotid Artery Revascularization (TCAR) reverses the flow of blood through the brain to send plaque dislodged during the procedure away from the brain and to an external filter where it’s captured, reducing the risk of stroke.

With TCAR, a 1-2 cm incision is made above the collarbone to access the carotid artery. A sheath is placed in the artery and connected to a system that reverses blood flow away from the brain. The balloon angioplasty and stenting are performed while blood flow is reversed, with the blood traveling through the filter outside of the body, removing any plaque before returning it through a vein in the patient’s thigh. Then, blood flow is returned to its normal direction.

Dr. Matthew Smeds, SLUCare vascular surgeon says, "That stent would be deployed into the carotid artery to kind of smash the debris up against the artery wall.  That's the flow reversal that protects you from having the stroke."

The procedure takes 45 minutes to 1.5 hours, can be done under local anesthesia, and requires a one-night hospital stay. The recovery time is very short, because of the very small incision – no muscles, tendons or body cavities are cut. It’s one of the easiest postoperative recoveries.  In 90% of cases, patients have undergone a carotid endarterectomy to remove plaque, which requires a 5-6 cm incision in the neck and a 1-2 day hospital stay.

Angioplasty and stent placement via the femoral artery is another option. The drawback is the danger of plaque breaking loose and flowing into the brain, increasing the chance of stroke.

A trial with high-risk patients indicated a 1.4 percent stroke risk following TCAR, compared to a 2.3 percent risk following a carotid endarterectomy. It has the lowest risk of stroke compared to the other options.

To learn more about TCAR or to book an appointment with a SLUCare vascular surgeon, click here.

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