Minimally Invasive Surgical Procedure to Treat Plaque in the Carotid Artery

Transcarotid artery revascularization (TCAR) is a minimally invasive procedure used to relieve a blockage in your carotid artery (carotid stenosis). If left untreated, carotid stenosis could lead to an interruption of blood flow to the brain, resulting in a stroke.

TCAR uses a special transcarotid neuro-protection system (NPS). Surgeons use the NPS device to temporarily reverse blood flow so that any plaque that may come loose while implanting the stent doesn't reach the brain and cause a stroke. The surgeon places a tube directly into the carotid artery and connects it to the NPS that directs blood flow away from the brain.

For more information, contact one of the vascular surgeons at TVH who perform the TCAR procedure: ​Brian Tiu, MDXiu-Jie Wang, MDBolaji Nafiu, MD or ​Yara Gorski, MD.

What is Carotid Stenosis?

Carotid stenosis, or carotid artery disease, is a narrowing or blockage of the carotid arteries. The carotid arteries carry oxygen-rich blood to your brain and are located in the side of your neck. If they become narrow or blocked, it can decrease blood flow to your brain, which could result in a stroke. About 800,000 people in the U.S. have a stroke each year.

You may show no symptoms of carotid stenosis until a stroke occurs. Symptoms of a stroke include:

  • Blurred vision
  • Confusion
  • Memory loss
  • Loss of sensation
  • Problems with speech and language, including loss of speech
  • Vision loss (partial or complete blindness)
  • Weakness in one part of your body
  • Problems with thinking, reasoning and memory

Call 9-1-1 immediately or go to an emergency room if you experience any of these symptoms, even if the symptoms go away after a short while. It could be a warning sign or a transient ischemic attack (TIA), which means you are at risk for a full-blown stroke.

Treatments for Carotid Stenosis

Treatment for severe carotid stenosis involves eliminating the artery blockage. The most common way to do that is with a surgery called carotid endarterectomy. It’s performed by making an incision along the front of the neck, opening the carotid artery and removing the plaque.

If the blockage is too difficult to reach using surgery, or if a patient has other health conditions that make surgery too risky, another option is carotid angioplasty and stenting. For this procedure, a catheter with a tiny balloon at the tip is threaded through an artery in the groin up to the area of the clog. The balloon is inflated to widen the artery, pushing the plaque to the side, and a small wire mesh coil, called a stent, is inserted to keep the artery open.

During both procedures, there is a risk that a stroke could occur if plaque is dislodged and travels to the brain. During angioplasty, there’s also a risk that blood clots may form on the catheter or plaque may break loose and travel to the brain, possibly leading to a stroke.

How TCAR Works

The new TCAR technique is a hybrid of the two techniques. It involves making a tiny incision at the base of the neck and inserting a stent into the carotid artery. While the stent is being placed, blood flow through the carotid artery is reversed temporarily. This is accomplished by inserting a small device into the carotid artery that removes the blood and reroutes it to a vein in the leg via a circuit outside the body.

That external circuit contains a pump to move the blood and a filter to remove any plaque that may break free from the artery during the procedure. With TCAR, a stent can be placed to open the artery and relieve the blockage, while the brain is protected from any debris that could lead to a stroke.

Research has shown that the temporary reversal of blood flow during TCAR is safe, and the treatment has been shown to have a lower stroke risk than traditional stenting or surgery. TCAR can be an attractive treatment alternative for many people who have severe carotid stenosis and are at high risk for stroke.

Watch this video to learn more about how the TCAR procedure works: