Transcarotid Artery Revascularization (TCAR)

TCAR treats carotid artery disease by compressing plaque against the artery walls and widening the narrowed portion of your carotid artery, so it remains open and continues to transport blood to your brain.

What to Expect
First, the vascular surgeon makes a small incision above your collar bone to access your carotid artery. Then your surgeon uses a tube with a built-in filter to connect the carotid artery with the femoral vein in your groin. This reverses the direction of blood flow during the procedure -- from the carotid artery, through the tube, and back into the femoral vein. This keeps vital oxygen flowing to your brain and ensures stray bits of plaque travel away from your brain and are filtered out before reentering your bloodstream.

Your surgeon inserts a thin wire through the narrowed area in your carotid artery and deploys a tiny balloon to push back plaque against your artery walls. Then a metal, mesh stent is inserted to keep the blood vessel open. Finally, surgeons remove the tube and close the femoral vein and carotid artery. Altogether, the TCAR procedure takes about 90 minutes.

While most people receive general anesthesia for TCAR surgery, you may be able to stay awake during the procedure to reduce the risks associated with general anesthesia.

Afterward, most people only stay one night in the hospital for observation. Wound healing usually takes two to three weeks. During follow-up visits, doctors use ultrasound imaging to ensure your new stent is working properly.

TCAR combines elements of two more traditional surgical approaches for treating carotid artery disease: carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS). 

• While CEA also requires an incision in the neck, the TCAR incision is much smaller and is located at the base of the neck rather than along the side.
   
• While TFCAS also uses a stent to trap plaque against artery walls and keep the vessel open, TCAR accesses your blockage more directly (through the neck versus through the groin). In addition, any shifting plaque is always directed away from the brain during TCAR, whereas during TFCAS, surgeons must first navigate a wire through the blockage before deploying an umbrella-like device to catch any debris.

Your doctor will discuss the differences between these procedures and recommend the best option for you.

Coordinated Stroke Prevention and Care
Duke’s team of vascular surgeons, vascular neurologists, and neurosurgeons offer the highest-quality care to minimize the risk of stroke in people with carotid artery disease and to quickly and effectively treat you if a stroke occurs. Duke’s certified stroke centers meet or exceed national standards and are accredited by The Joint Commission.

Qualified, Experienced Surgeons
Our vascular surgeons perform hundreds of procedures to open blocked carotid arteries each year, and many have decades of experience in carotid artery stenting. Duke researchers helped study TCAR technology before and after its FDA approval in 2015.