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Transcarotid Artery Revascularization (TCAR)

Transcarotid artery revascularization (TCAR) offers a safer method of carotid stenting which significantly reduces the risk of stroke and heart attack. Stroke is a leading cause of death in the United States, as well as a leading cause of adult disability. This life-threatening medical condition occurs when the blood vessels that carry oxygen and nutrients to the brain become blocked or burst. When brain cells lose access to blood and oxygen for an extended period of time, they begin to die. This can lead to both transient ischemic attack (TIA) and stroke.

AnMed Health in Anderson, South Carolina is one of a select number of hospitals in the United States offering this innovative procedure.

What is Transcarotid Artery Revascularization?

TCAR is a minimally invasive procedure used to treat carotid artery disease and prevent stroke. TCAR is a clinically proven preventative measure against strokes linked with better outcomes than carotid endarterectomy surgery (CEA). It has been described as a more successful hybrid of currently available treatments for carotid artery disease.

During conventional CEA surgery for stroke prevention, there is a risk of plaque breaking off, traveling to the brain, and causing the stroke the surgery is intended to prevent. TCAR treatment uses a cutting-edge transcarotid neuro-protection system (NPS) which allows the vascular surgeon direct access to the common carotid artery and avoids the risk associated with traveling further up from the femoral artery.

Additionally, this approach mitigates the risk of stroke through the use of temporary reverse blood flow technology which diverts plaque away from the brain.

TCAR is considered to be a much safer method of carotid stenting than alternate stenting procedures. It significantly reduces the risk of stroke and heart attack for patients with carotid artery blockage, both during and after treatment.

How Does TCAR work?

The TCAR  procedure takes place in an operating room under local or general anesthesia depending on the recommendation of the vascular surgeon performing the surgery.

The surgeon makes a small incision on your neck in the area just above the clavicle. A tube is then placed directly into the carotid artery so that the doctor does not have to navigate through the aortic arch, which is linked to stroke during certain stenting procedures.

The tube is then connected to the NPS system, which temporarily directs blood flow — and any dislodged plaque — from traveling to the brain. Blood flows through the system, which captures any plaque in a filter outside the body. The filtered blood is then returned into the body through a second tube inserted in the upper leg.

The procedure concludes with the placement of the carotid stent, which expands the carotid artery in order to increase blood flow. After the successful placing of the stent, the surgeon will turn off the blood flow reversal.

Who needs Transcarotid Artery Revascularization?

For patients with carotid artery disease that are at high-risk for CEA, TCAR is a viable option that’s clinically proven and minimally invasive. TCAR treats carotid artery disease and helps prevent future strokes. Your doctor may recommend TCAR if you’ve been diagnosed with carotid artery disease and the procedure is safe for you based on your personal medical history and conditions.

Carotid artery disease is most often caused by atherosclerosis, or the build-up of fats and cholesterols in the artery walls. Various risk factors for atherosclerosis include the following:

  • Age
  • Gender
  • Family History
  • Race
  • Genetics
  • Smoking
  • Weight
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Diet
  • Exercise

While these factors may increase an individual’s risk, they don’t necessarily cause the disease. However, understanding your risk factors can help you make appropriate lifestyle changes and work with your healthcare team to reduce your chances of getting atherosclerosis.

Carotid artery disease is diagnosed through thorough testing, which may include listening to the carotid arteries, a carotid artery duplex scan, an MRI scan, magnetic resonance angiography (MRA), computed tomography angiography (CTA), and angiography.

Not all patients with atherosclerosis and carotid artery disease require surgical intervention. In cases where the carotid artery is less than 50 percent narrowed, treatment via lifestyle changes and medicine may be advised. In cases where the artery is narrowed to between 50 percent and 70 percent, the healthcare provider may recommend medicine or surgery, depending on the specifics of the case.

All people with carotid disease are not good candidates for TCAR. In order to determine a patient’s best treatment options, a number of factors are considered including the following:

  • Age
  • Overall health and medical history
  • Degree of sickness
  • Capacity  to handle certain procedures, therapies and medications
  • The estimated length of the condition
  • The patient’s opinion and/or preference

Many patients with carotid artery blockage have been successfully treated with TCAR. It may be recommended for you if you meet the following criteria:

  • Your vascular surgeon has diagnosed you with carotid artery disease that needs clinical intervention.

AND

  • You are at high risk for carotid endarterectomy  (open surgery) due to your age, anatomy, or an alternate medical condition.

What are the Benefits of TCAR?

TCAR is regarded as best in class stroke prevention. This new and exciting procedure offers several benefits to patients, including the following:

  • A smaller incision and less scarring
  • Less time in the operating room
  • Shorter hospital stays
  • Faster recovery
  • Reduced risk of a procedural stroke
  • A lower reported stroke rate following the procedure

What are the Risks of TCAR?

All surgeries involve a certain degree of risk. While TCAR has been proven to minimize the risk of stroke caused by carotid artery stenosis, there are still potential risks involved in the procedure. These include:

  • Stroke, heart attack or death
  • Carotid artery or cranial nerve damage
  • Bleeding, bruising, and swelling at the surgical access site
  • However, most physicians agree that the benefits of TCAR far outweigh the risks — both in terms of managing carotid artery disease and as an alternative to more potentially dangerous procedures, such as conventional carotid endarterectomy surgery.

How to Prepare for TCAR

Once it’s determined that surgical intervention is required for a patient with carotid artery disease, the vascular surgeon will perform a number of tests. These may include routine blood work, carotid artery ultrasound, and angiography. The doctor will also determine whether the patient has any allergies or is taking any medications which could affect the surgery.

Prior to the surgeon, patients are asked to take aspirin or another antiplatelet medication and cholesterol-lowering medications, including statins. Research indicates that certain statins can increase the size of the artery’s opening while decreasing the thickness of the artery wall. Most patients are also asked to refrain from eating and drinking in the hours leading up to the TCAR procedure.

What to Expect after TCAR

One of the benefits of the TCAR procedure is a quick recovery time. Patients typically spend just a single night in the hospital. Prior to being discharged, patients are given specific instructions regarding activity, diet, and medications.

Most patients are asked to refrain from heavy lifting and other hard physical activities for a minimum of a week. They are provided specific instructions regarding when they can safely return to work and resume normal activities.

The doctor will also prescribe medications to prevent blood clots from forming in the newly expanded carotid arteries.

Patients are closely monitored during recovery from TCAR. A follow-up ultrasound will be scheduled to identify whether any narrowing has occurred within the artery.

Additionally, patients are encouraged to embrace healthy lifestyle changes, such as through diet and exercise. While these modifications may be minor for some people, they may be more significant for others.

Lastly, patients with carotid artery disease should avoid smoking.

TCAR vs. CEA

Carotid endarterectomy (CEA) is the conventional surgery used to treat carotid artery disease. Like TCAR, it involves the removal of plaque and blood clots from the carotid arteries. It is also recommended as a preventative measure for people who have symptoms with a carotid artery narrowing of more than 70 percent.

While both procedures use an implanted stent in the carotid artery to promote blood flow and protect patients from future stroke risk, TCAR is less invasive than conventional carotid endarterectomy surgery (CEA), which is a surgical procedure in which the vascular surgeon opens the artery and removes the plaque before stitching the artery back together.

TCAR is also linked with better results than transfemoral carotid stenting, another technique used to treat carotid artery disease. While transfemoral carotid stenting is a minimally invasive procedure like TCAR, studies show that it may dramatically increase the risk of stroke.

Why Choose AnMed Health for your TCAR Procedure?

Located in Anderson, South Carolina, AnMed Health has been providing high-quality healthcare to residents of eight counties in South Carolina and Georgia for more than a century. We are the state’s largest, independent health system. With a staff of more than 400 doctors and more than 3,600 employees, we are also Anderson County’s largest employer.

With the vision of blending consummate care with the latest medical research, AnMed is a perfect fit for patients looking to benefit from the latest advancements in medicine and technology, including the revolutionary TCAR procedure. Our overarching goal is to optimize the health of our patients and community, and the TCAR procedure offers an ideal means of doing so for today’s carotid artery disease patients.

Fully accredited by DNV GL Healthcare, AnMed Health has earned many outstanding accreditations in specific areas of care, including being a Top Performer on Key Quality Measures for excellence in heart attack, heart failure, pneumonia, and surgical care. It also works closely both internally and externally to maintain low hospital-acquired infection rates.

In 2013, AnMed Health was recognized by the Joint Commission, in conjunction with the American Heart Association and American Stroke Association, with Advanced Certification for Primary Stroke Centers. The honor signifies AnMed’s commitment to and long-term success with supporting the best outcomes for stroke patients.

Contact AnMed Health About TCAR

Unfortunately, carotid artery disease does not present any immediate symptoms. In fact, the first sign that the disease is present may be a transient ischemic attack (TIA) or stroke.

This is why routine checkups are an invaluable preventative health measure. Symptoms of TIA stroke may include sudden weakness, clumsiness or paralysis on one side of the body; movement and coordination difficulties; the decreased ability to concentrate, confusion, dizziness, fainting, and headache; numbness and/or loss of feeling in the face, arm or leg; temporary blurred vision or loss of vision; and slurred speech. If you or someone you love is having any of these symptoms, it is a medical emergency and you should call for help right away.

AnMed Health is ready to help you with any of your healthcare needs, including questions about carotid artery disease and whether TCAR is the right fit for your health goals and needs. Contact us today to schedule an appointment to discuss the TCAR treatment in Anderson or to consult with a member of the AnMed team of healthcare professionals regarding another concern.