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By Frank R. Arko, MD

Patients with carotid stenosis have historically had two options: carotid endarterectomy or stenting. Both procedures are effective but have notable drawbacks, including the risk of a stroke during the procedure. Fortunately, a minimally invasive procedure called transcarotid artery revascularization (TCAR) offers the same results but with a faster recovery, low risk of stroke, and reduced risk of heart attack and cranial nerve injury.

At Sanger Heart & Vascular Institute we’ve performed over 130 TCAR procedures, while limiting the stroke risk to approximately 1%.

Downsides to Endarterectomy and Stenting

Endarterectomy has long been the gold standard for treating carotid stenosis, but it requires a 5-6 cm incision and some dissection of the neck. This lengthens recovery time and increases the risk of issues with major nerves in the neck.

Stent placement via the femoral artery is a second but less common option. This procedure is less invasive but can increase stroke risk by knocking plaque into the bloodstream and has been demonstrated to have a higher risk of stroke than standard surgery.

How TCAR Works

With TCAR, a 1-2 cm incision is made above the clavicle to access the carotid artery. Then a sheath is placed in the artery and connected to a neuroprotection system (NPS) that reverses blood flow and diverts emboli away from the brain.

From there, balloon angioplasty and stenting are performed while the flow is reversed. Any loose plaque is captured in a filter outside the body before the blood is returned. After the stent is placed, we turn off the NPS, and blood flow resumes its normal direction.

Faster Recovery, Lower Stroke Risk

TCAR takes between 45 and 90 minutes, and patients typically go home the next day. The small incision means limited risk to cranial nerves and a faster, less painful recovery.

Findings from the ROADSTER trials confirm the increased benefits of TCAR to patients. In ROADSTER 1, the 30-day stroke rate after TCAR was 1.4 percent, compared to a 2.3 percent stroke rate for carotid endarterectomy.

Sanger was a key study site for ROADSTER 2, which showed an even lower incidence of strokes within 30 days – just .64 percent. What’s more, participants also had lower rates of acute and permanent cranial nerve injury than is typically observed in patients undergoing endarterectomy.

Why Sanger Heart & Vascular Institute?

While TCAR isn’t approved yet, we can offer it to your patients through the Vascular Quality Initiative TCAR Surveillance Project at three of our locations: Charlotte, Pineville and Concord. As one of the region’s first centers to offer TCAR, we have unparalleled experience with the procedure. In fact, all of our surgeons have been trained and accredited in TCAR, and we were recently named a TCAR Center of Excellence – a testament to our high volumes and top outcomes.

For more information, or to make a referral, call 877-999-7484.

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