Transcarotid artery revascularization (TCAR)

Transcarotid artery revascularization (TCAR) is a ground-breaking, minimally invasive surgical procedure used to treat plaque in the carotid artery, which if left untreated could cause a stroke. Instead of removing the plaque, this technique involves relining the plaque and covering so that it can remodel. This method takes the techniques used in traditional carotid endarterectomy (open surgery) to the next level with the addition of a device that draws blood away from the brain to filter it, limiting the chances that any plaque will enter the blood stream during surgery. This results in a less-invasive, safer method that reduces the risk of stroke during the procedure.

TCAR is performed to prevent a stroke caused by carotid atherosclerosis, a gradual buildup of plaque in arterial walls, specifically in the carotid arteries. The carotid artery is the direct supplier of blood to the brain. Therefore, if built up plaque in the artery breaks off, it can travel to the brain and cause a stroke.

Our goal is to ensure you receive the highest quality of care for your condition, and our early implementation of cutting edge technologies like TCAR is how we achieve it. We are one of just a few health systems in the New York area performing this procedure, and our surgeons are leading the charge for making this treatment a staple in vascular care. Our state-of-the-art hybrid operating rooms are equipped with the most advanced imaging technology, which allows us to create high-precision images. Our surgeons are well-versed in the latest minimally invasive technologies, as well as traditional surgical approaches to treating vascular conditions like carotid atherosclerosis. This means that no matter what treatment option is the best fit for your unique circumstances, you can rely on our team to deliver top-tier, compassionate care.

Risk factors for atherosclerosis include old age, history of smoking, diabetes and high blood pressure. These factors can also put you at risk for complications during treatment, though TCAR has been shown to reduce that risk substantially.

Because TCAR is a minimally invasive procedure, it comes with less risk than more invasive surgeries, such as carotid endarterectomy, a procedure used to treat carotid artery disease through an incision in the neck. However, as with any treatment, there are still complications to consider. As with all procedures, risks of this procedure include bleeding, infection, blood clots, stroke and a heart attack. We’re unrelenting about reducing the risk of these complications. That’s why we rely on top-of-the-line imaging techniques as well as thorough examination to determine whether you are a suitable candidate for the procedure.

We often perform TCAR under local anesthesia. Once your neck is fully anesthetized, we make a very small incision just above the clavicle. Then, we insert a small needle with a very fine wire attached to it into the carotid artery. We use the wire to place a small sheath, or protective covering, in the artery, which is connected to the flow reversal device. The device is used to draw blood away from the brain and return it to your body though a catheter we insert into a vein near your groin. Before your blood reenters your body, it passes through a filtering device that removes any existing plaque. Next, we place a small stent in the carotid artery, and a tiny balloon is inflated to open the blockage and separate the plaque particles. The balloon is removed and the stent remains to keep the artery open, reducing the risk of a stroke.

Often, no change in your routine medications is required. Your doctor will instruct you how to manage your preprocedural medications. Additionally, you can expect to undergo a series of imaging tests, which help us analyze every detail of your condition before your procedure.

TCAR is well-tolerated by patients, and thus recovery time is relatively minimal. Most patients are able to leave the hospital the following day. You may experience some pain at the insertion sites, but this should be manageable with over-the-counter medications as directed by your doctor.

TCAR is clinically proven to significantly reduce the risk of stroke during surgery, and it's very successful in safely treating plaque from the carotid artery. However, it is important to note that without proper lifestyle changes, atherosclerosis can reoccur in the carotid arteries or other parts of the body. We suggest living a healthy and active lifestyle, carefully managing any pre-existing conditions (like diabetes or high cholesterol) and quitting smoking. Since atherosclerosis is a condition that can reoccur, we will likely have you back regularly to ensure there are no issues or complications.