Transcarotid Artery Revascularization (TCAR) is a minimally invasive surgical procedure used to treat carotid artery disease, a condition characterized by the narrowing of the carotid arteries that supply blood to the brain. The procedure opens up the narrowed carotid artery and restores normal blood flow to the brain. TCAR combines elements of both traditional open surgery and endovascular techniques to safely and effectively treat carotid artery blockages.
Treatments
TCAR is primarily used to treat patients with significant carotid artery stenosis (narrowing) who are at high risk for complications from traditional open surgery or have other contraindications to carotid endarterectomy (CEA). TCAR offers a less invasive approach with potentially faster recovery and lower rates of complications.
Before the Procedure
Before undergoing TCAR, a comprehensive evaluation is conducted to assess the patient’s overall health and determine their suitability for the procedure. This evaluation may involve medical history review, physical examinations, imaging tests (such as ultrasound, CT angiography, or magnetic resonance angiography), and blood tests. The patient’s risk factors and medical conditions are assessed to ensure the appropriateness of TCAR.
During the Procedure
The TCAR procedure typically involves the following steps:
- Anesthesia: The patient is given local anesthesia to numb the incision site and conscious sedation to relax during the procedure.
- Incision and Catheter Placement: A small incision is made just above the collarbone, and a sheath is inserted into the carotid artery.
- Blood Flow Reversal: A specialized system is used to divert blood flow away from the brain, filtering and returning it to the body through a second sheath in the thigh.
- Stent Placement: With the blood flow reversed, a stent is placed through the sheath in the neck to open and support the narrowed carotid artery.
- Completion and Incision Closure: Once the stent is securely in place, blood flow is restored to its normal direction. The sheaths are removed, and the incision is closed with sutures or adhesive strips.
After the Procedure
After TCAR, the patient is closely monitored in a recovery area for a brief period. Blood pressure, heart rate, and other vital signs are monitored. The patient may be discharged the same day or require an overnight stay for observation.
Advantages of TCAR
- Minimally Invasive: TCAR is a minimally invasive procedure that offers a smaller incision and reduced trauma compared to traditional open surgery.
- Reduced Stroke Risk: TCAR utilizes a blood flow reversal system to prevent emboli from reaching the brain during the procedure, reducing the risk of stroke.
- Shorter Recovery Time: TCAR generally allows for a faster recovery and shorter hospital stay compared to traditional carotid surgery.
- Suitable for High-Risk Patients: TCAR provides an alternative treatment option for patients at high risk for complications with other procedures.
Risks and Complications
Although TCAR is considered a safe procedure, it carries certain risks and complications, including:
- Stroke: Although rare, there is a risk of stroke during or after the procedure.
- Bleeding: There is a potential risk of bleeding at the incision site or from the puncture sites in the arteries.
- Infection: Infection is a possible complication, but it is relatively uncommon.
- Nerve Injury: Damage to nerves in the neck region may occur during the procedure, leading to temporary or permanent weakness or numbness.
Typical Recovery Time
The recovery time after TCAR varies depending on the individual patient and their overall health. In most cases, patients can resume normal activities within a few days to a week after the procedure. However, it’s important to follow the specific post-procedure instructions provided by the healthcare team.
Results and Post-Procedure Care
TCAR has shown positive outcomes in terms of reducing the risk of stroke and improving blood flow to the brain. Following the procedure, post-procedure care may include:
- Regular follow-up appointments with the healthcare team to monitor the healing process and overall vascular health.
- Medication adherence, including prescribed medications to prevent blood clots and manage other cardiovascular risk factors.
- Lifestyle modifications, such as a heart-healthy diet, regular exercise, and smoking cessation, to promote overall vascular health.
- Monitoring for any signs of infection, bleeding, or other complications, and promptly seeking medical attention if any concerns arise.
If you have specific concerns about a procedure or your health, please consult a physician.