Dr. Rose from Cardio-Thoracic and Vascular Surgical Associates (CTVSA) joined us on Studio10 to tell us about the TCAR Procedure that they have to offer.
The following questions and answers were provided by CTVSA:
TCAR (Transcarotid Artery Revascularization)
What is carotid disease and why do we care?
Carotid artery disease is estimated to be the source of stroke in up to a third of cases, and there are 400,000 new diagnoses of carotid artery disease each year made in the US.
How do you treat carotid artery disease?
Most cases of carotid artery disease are managed primarily with medical treatments including aspirin, statin, smoking cessation, and optimization of blood pressure and diabetes.
Surgical interventions are indicated for patients who have stroke-like symptoms when the carotid artery disease or plaque is present that narrows the vessel to more than 60%. For patients without symptoms, surgical intervention is indicated when the vessel is narrowed to 80% or more.
What kinds of surgical interventions are available?
Carotid interventions include carotid endarterectomy, carotid stenting and now TRANSCAROTID ARTERY REVASCULARIZATION or TCAR.
What is TCAR?
TCAR is a minimally-invasive, endovascular procedure that incorporates the benefits of traditional carotid endarterectomy and stenting.
CEA technique, CAS technique..
Transcarotid artery revascularization (TCAR) is carried out by initially creating a small incision in the neck, connecting an arterial sheath to a venous sheath in the femoral vein and creating a dynamic reversal flow from high arterial pressure to low venous pressure. A neuroprotective flow reversal mechanism collects debris from the carotid plaque and captures it into a device filter. By placing the clamp in the carotid artery in TCAR, the surgeon is able to provide a CEA-like protection after which a carotid stent is placed.
Who would be a candidate for TCAR?
TCAR is well-suited for patients at higher surgical risk of traditional endarterectomy due to age, comorbid conditions such as heart failure or COPD or have anatomical issues that preclude endarterectomy or stenting.
Certain anatomical criteria must be met to be considered for the procedure and our ultrasonographers look for these criteria when they perform carotid duplex ultrasounds at our clinic.