Transcarotid artery revascularization (TCAR): A minimally invasive way to reduce stroke risk

Carotid artery disease is usually diagnosed in one of three ways:

• You have mini-stroke symptoms, which can include short episodes of weakness, numbness or paralysis in the face, arm or leg; slurred speech; vision impairment, double vision, dizziness or loss of balance;

• You receive a scan or X-ray for another reason and doctors discover that you have carotid artery disease; or

• During a physical exam or clinic visit, a doctor hears an unusual swishing sound (called bruit) in your blood flow.

Carotid artery disease typically occurs in patients who:

• Are 55 or older

• Have high blood pressure (hypertension)

• Already know they have heart or vascular disease, i.e. they are already being treated for clogged arteries in the heart, neck or legs

• Smoke

If a patient has significant (at least 70% to 80%) blockage in a carotid artery, we typically recommend more aggressive treatment to remove the fatty plaque. This typically involves one of two options, and your doctor will discuss the advantages and risks of each with you:

• Carotid endarterectomy. This is a surgical procedure that typically requires a one-night stay in the hospital. The surgeon makes an incision in the front of the neck, removes the plaque and repairs the artery with stitches or a patch.

• TCAR, or transcarotid artery revascularization. TCAR is a newer, less invasive yet equally effective approach for many patients. It involves placement of a small wire mesh tube, or stent, that keeps the carotid artery open and restores normal blood flow. UW Health was among the first academic medical centers to offer TCAR when, in 2016, clinical trials were launched that demonstrated the safety and effectiveness of this procedure.

Benefits of TCAR

TCAR also requires a one-night hospital stay, but offers several advantages that many patients find appealing:

• Compared with surgery, the incision is smaller (usually less than one inch) and is made in a less obvious location at the base of the neck.

• Recovery time is shorter

• Risk is lower for certain patients, such as those with severe heart or lung disease, or those who have had previous neck surgery

• During the TCAR procedure, the surgeon temporarily reverses the blood so it flows away from the head rather than toward the head. This protects the brain from a stroke that could be caused by any inadvertent plaque that breaks away during the procedure.