BMN Blog

JUN 22

Potential complications of both surgery (carotid endarterectomy or CEA) and conventional stenting (accessed from the groin) for stroke prevention in patients with carotid artery disease occur during or after the procedures. Studies have shown a higher risk of stroke during conventional stenting as compared to surgery and a higher risk of heart attack and wound complication with surgery as compared to conventional stenting.

The newer minimally invasive TransCarotid Artery Revascularization (TCAR) procedure that uses a special neuro-protection system (NPS) is designed to reduce the risk of stroke during the insertion of the stent.

The novel NPS device allows the surgeon to directly access the common carotid artery in the neck and initiate high-rate temporary blood flow reversal to protect the brain from stroke while delivering and implanting the stent.

The TCAR procedure is performed using a multispecialty approach with an Interventional Cardiologist and a Cardiovascular Surgeon. The surgeons make a small incision at the neckline just above the collar bone, and place a tube directly into the carotid artery from which it is connected to the NPS that directs blood flow away from the brain to protect against plaque that may come loose reaching the brain.

The TCAR procedure offers patients a safer method of carotid stenting through a small incision at the base of the neck and direct carotid artery access along with neuro-protective flow reversal during delivery of the stent.

The patient's blood flows through the NPS and any material is captured in a filter outside the body. The filtered blood is then returned through a second tube in the patient's upper leg vein. After the stent is placed successfully by the cardiologist, flow reversal is turned off and blood flow resumes in its normal direction.

TCAR not only prevents the need to navigate catheters through the aortic arch when carotid stenting is done through the groin, but also eliminates fragments of plaque released during stenting from traveling in the bloodstream to the brain causing small or bigger strokes.

At the Heart & Vascular Center at St. Vincent’s East, we treat all aspects of vascular disease frequently including high-risk patients who are turned away by other physicians said Bob Foster, MD, who is an interventional cardiologist at Birmingham Heart Clinic.

With the assistance of Trent Howard, MD of CV Surgery, TCAR requires a smaller incision compared to conventional carotid stenting resulting in decreased risk for nerve damage, a faster recovery time and fewer cardiac and wound complications.

Offering this newer minimally invasive treatment option that allows blood flow reversal protection to our patients with carotid artery blockage is advancing patient care by dramatically reducing the risk of stroke and heart attack during and after carotid interventions.

Robert Foster, MD is an interventional cardiologist at Birmingham Heart Clinic.

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