For people with severe blockage in their carotid arteries, called carotid artery disease or carotid stenosis, a less invasive surgical option is now available at St. Vincent Healthcare that can decrease the risk of intraoperative stroke.
“The carotid arteries feed blood to the brain,” explained Thomas Desmarais, MD, a vascular surgeon at SCL Health Heart & Vascular Institute in Billings, part of Intermountain Health. “There's a particular area where plaque can form, and if that plaque breaks off, it can travel to the brain, causing a stroke.”
The body has two carotid arteries, one on each side of the neck. If left untreated, carotid artery disease can often lead to stroke; it is estimated to be the source of stroke in up to a third of cases, with 427,000 new diagnoses of the disease made every year in the U.S. alone.
In 2020, St. Vincent Healthcare became the first hospital in the region to treat carotid artery disease and prevent future strokes using a procedure called transcarotid artery revascularization (TCAR).
What is TCAR?
TCAR is a clinically proven, minimally invasive and safe approach for high surgical risk patients who need carotid artery treatment. St. Vincent’s vascular surgery team is committed to providing excellent care to vascular patients and the TCAR procedure helps ensure the best outcome for patients needing carotid artery treatment.
TCAR is unique in that blood flow is temporarily reversed during the procedure so that any small bits of plaque that may break off are diverted away from the brain minimizing the risk of a future stroke.
“This allows us to be able to place a stent more safely,” Dr. Desmarais said.
There are other reasons to consider TCAR, Dr. Desmarais said. “It is 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.”
Now more patients are eligible
Initially, TCAR was reserved mostly for patients who have a high risk of complications, Dr. Desmarais said. Recently, though, data for TCAR has been so favorable that eligibility has opened to more patients, giving it a bigger role in how the hospital cares for patients with carotid artery disease. Hospitals must keep track of their outcomes in a national registry, he said.
St. Vincent Healthcare became the first hospital in Montana to offer TCAR and remains one of only two facilities in the state to perform the procedure.
"Being able to offer our patients TCAR means they don't have to face the added burdens that come with needing to travel for care," explained Dr. Desmarais. "We're committed to keeping our patients close to home whenever possible."
Incidence rate and risk factors
In people over age 60, the incidence of asymptomatic carotid disease is between 2% and 8%, depending on risk factors. Those risk factors may include high blood pressure, high cholesterol, diabetes, obesity, tobacco or alcohol use, increased age, and ethnicity.
Talk to your doctor if you have risk factors for carotid artery disease. Early intervention increases your chances that carotid artery disease will be found and treated before a disabling stroke occurs.
Learn more at svh.org/vascular.