St. Vincent Healthcare is the first hospital in the region to treat carotid artery disease and prevent future strokes using a new procedure called TransCarotid Artery Revascularization (TCAR). TCAR (tee-kahr) is a clinically proven, minimally invasive and safe approach for high surgical risk patients who need carotid artery treatment.
Carotid artery disease is a form of atherosclerosis, or a buildup of plaque, in the two main arteries in the neck that supply oxygen-rich blood to the brain. 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.
St. Vincent Healthcare’s vascular surgery team, Dr. Kevin Bruen, Dr. Jeff Horn, and Dr. Thomas Desmarias, are 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 an important new option in the fight against stroke, and is particularly suited for the large portion of patients we see who are at higher risk of complications from carotid surgery due to age, anatomy, or other medical conditions,” said Dr. Thomas Desmarais, Vascular Surgeon. “Because of its low stroke risk and faster patient recovery, I believe TCAR represents the future of carotid repair.”
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, preventing a stroke from happening. A stent is then placed inside the artery to stabilize the plaque, minimizing the risk of a future stroke.
Prior to TCAR, the main treatment option for severe carotid artery disease was an open surgical procedure called carotid endarterectomy (CEA). CEA removes plaque from inside the carotid artery to restore normal blood flow to the brain, but the large incision leaves a visible scar the length of the neck and carries risks of surgical complications, including bleeding, infection, heart attack and cranial nerve injuries that can cause issues with swallowing, speaking and sensation in the face.
The TCAR procedure was developed by Sunnyvale, California-based Silk Road Medical, Inc. and includes the ENROUTE® Transcarotid Neuroprotection (NPS) and Stent System – the first devices designed and FDA-approved specifically for TCAR. Over 10,000 TCAR procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent.
To view an informative video about the TCAR procedure, click here or the image above.
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 10,000 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 future strokes. 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.