Transcarotid Artery Revascularization (TCAR)

The TCAR procedure is a minimally invasive treatment for a narrowed carotid artery, performed through a small incision at the neckline. It was designed to reduce the risk of stroke associated with traditional open surgery. TCAR is an option for patients who are not good candidates for open surgery due to their age, medical conditions or other anatomic issues.

How does it work?

The surgeon makes a small incision above the collarbone and inserts a stent into the carotid artery. During the procedure, the patient’s blood flow is temporarily reversed to flow away from the brain which protects it from bits of plaque that may dislodge during the procedure. This reduces the risk of stroke. Once the stent is in place, to keep the carotid artery open, normal blood flow is restored.

Why is it done?

TCAR is used to treat carotid artery disease. Calcified and potentially fatty substances, known as plaque, can collect and stick to the linings of the arteries. This narrows the arteries which limits blood flow to tissues and organs, which is a condition called arterial stenosis. The carotid arteries supply oxygen-rich blood from the heart to the brain. When stenosis occurs in the carotid arteries, a piece of plaque can flake off and flow downstream to the brain resulting in a stroke.

The TCAR procedure is less invasive and has potentially fewer risks than other carotid artery treatment options: traditional open surgery and transfemoral stenting. TCAR usually requires a shorter hospital stay and has a faster recovery time. The most significant benefit is the lower risk of stroke.

You will receive general anesthesia so that you do not feel any pain during surgery and you will not be awake or remember the surgery.

Once you are asleep, the surgeon will make a small incision in your neck and insert a tube into the carotid artery. The tube will be connected to a machine that will direct your blood flow away from your brain, to make sure that any dislodged plaque does not reach your brain. Blood flows through the machine and into a filtered compartment outside your body. The filtered blood will be returned through another tube in your leg.

When the stent has been placed in the carotid artery, the blood-flow machine will be disconnected, and the incisions will be closed.

Like all surgical procedures, TCAR involves some risks. These may include:

• Bleeding or infection at the incision site
• Damage to the carotid artery
• Stroke
• Heart attack
• Death

When your TCAR procedure is complete, you will most likely stay in the hospital for one night.

Once you return home, you will need to avoid strenuous activity for about a week, or as advised by your physician. While TCAR has a faster recovery than traditional open surgery, be sure to talk with your physician about when it is safe to resume daily activities.

To reduce the risk of a re-occurring blockage in the carotid artery, it is important to maintain any lifestyle changes recommended by your doctor. These could include eating a healthy diet, exercising daily and not smoking.

Memorial Hermann-affiliated heart and vascular specialists are committed to using a multidisciplinary approach to provide exceptional care. Our highly skilled practitioners utilize leading-edge technology to diagnose and treat cardiovascular concerns.

Carotid artery disease is a serious but treatable condition. To learn more about treatment options, including TCAR, visit Find A Doctor to schedule an appointment.