Your carotid arteries are like thoroughfares in the neck that supply blood to the brain. Over time, they often build up with artery-clogging plaque, which reduces that blood flow and increases the risk of stroke. For years, the only way to remove this plaque was by scraping it out through long incisions in the neck (carotid endarterectomy) or by feeding a stent through many inches of tubing from the groin to the neck. Both procedures are effective, but not everyone is a candidate for one or the other.
Now there is a third option for treating carotid artery disease. Overlook Medical Center is the first hospital in the state to offer TCAR (transcarotid artery revascularization), a minimally invasive procedure performed through a small incision at the neckline. The surgeon places a tube directly into the carotid artery and connects it to a protective device that temporarily directs blood flow away from the brain, thereby preventing any plaque from reaching the brain; any loose material is captured in a filter outside the body. After the stent is placed to stabilize the plaque in the carotid artery, the flow reversal is turned off and blood flow to the brain resumes in its normal direction.
“This is a hybrid of the other procedures,” says vascular surgeon Mark Kumar, MD. “It provides the benefits of stenting with the benefits of direct access to the carotid artery, with an easier recovery, less pain and a safer way to stent.”
TCAR also widens the treatment population to patients who are not well suited for either of the traditional procedures. “Patients who are older than 80 and patients with an increased cardiac risk are generally not candidates for carotid endarterectomy or stenting, but they may be candidates for TCAR,” says vascular surgeon Scott Sundick, MD.
Adds Clifford Sales, MD, chief of the division of vascular surgery for Overlook Medical Center, “Overlook is one of the busiest sites in the state for carotid care. What sets us apart is that we do all three procedures, and we do them well. We choose the procedure that is best for the patient.”