Using the latest state-of-the-art technology, the TransCarotid Artery Revascularization (TCAR) procedure offers a clinically-proven, minimally-invasive alternative to surgery to treat carotid artery disease. TCAR uses an advanced system for accessing the carotid artery, protecting the brain, and addressing blood flow.
More than 15 million people suffer a stroke (also known as a “brain attack”) worldwide each year causing almost 6 million deaths and leaving another 5 million people disabled. Carotid artery disease is a leading cause of stroke, and over 400,000 patients in the U.S. are diagnosed with the disease annually.
Until now, surgical treatment to correct carotid artery disease was with open surgery — an operation that left considerable scarring and heightened the risk of complications.
“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,” says Adam B. Levitt, M.D., R.V.T., F.A.C.S., a board certified vascular surgeon at Vascular Specialists of Central Florida.
“Because of its low stroke risk and faster patient recovery, I believe TCAR represents the future of carotid artery repair.”
What Is Carotid Artery Disease?
The carotid arteries of the neck represent the main pathways providing oxygen-rich blood to the brain. When gummy plaque builds up in the carotid arteries (a process known as atherosclerosis), blood flow to the brain is impeded; as a result, the plaque can break off and get lodged in the brain, and a stroke can occur.
When the brain is denied blood flow for even a few minutes, its cells will begin to die; therefore, different parts of the body controlled by the brain will become dysfunctional, causing brain damage, vision or speech impairments, paralysis, and even death.
Smoking, obesity, high levels of cholesterol, high blood pressure, elevated blood sugar from diabetes, and physical inactivity can damage the inner lining of the carotid arteries. Some individuals can manage carotid artery disease with medications and lifestyle changes. However, more severe cases may require surgery to repair the blockage in the artery.
How Does TCAR Work?
TCAR uses a specialized tube to temporarily reverse blood flow during the procedure inhibiting tiny portions of plaque that may break off from reaching the brain and 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 primary treatment option for severe carotid artery disease was an open surgical procedure called carotid endarterectomy (CEA). CEA removed plaque from inside the carotid artery to restore normal blood flow to the brain, but the large incision left a visible scar the length of the neck and carried risks of surgical complications, including
- Heart attack
- 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 3,000 TCAR procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent.
Based on published clinical trials, the procedure offers several advantages:
- Better outcomes
- Less invasive
- Performed in less than half the time of CEA open surgery
- Faster recovery
With TCAR, local anesthesia is favored, and hospital stays are typically overnight for observation. TCAR patients recover quickly and almost always go home the next day to return to full and productive lives with less pain, smaller scars, and the risks of both minor and major complications are significantly decreased.
TCAR procedures for symptomatic and asymptomatic patients at high risk for surgery are eligible for Medicare reimbursement through the Society of Vascular Surgery-sponsored TCAR Surveillance Project. This program is part of the Vascular Quality Initiative, an open registry that tracks long-term clinical outcomes to promote best practices and evidence-based medicine.
If you have been diagnosed with carotid artery disease and would like to schedule a consultation to see if the TCAR procedure is right for you, please contact us.