The carotid arteries are vital blood vessels in the neck that supply blood to the brain. With stenosis (narrowing) from fatty deposits, or plaque, a person with carotid artery disease has a higher risk of stroke and other complications.
The newest procedure to safely place a stent in a narrowed carotid artery — to lower the risk of stroke — is now being performed at Miami Cardiac & Vascular Institute [1], part of Baptist Health South Florida.
It’s called TCAR, which stands for “transcarotid artery revascularization.” This innovative system does something remarkable that helps high-risk patients. It actually reverses blood flow temporarily away from the brain. This “flow reversal” — as surgeons call it — protects the patient against plaque that may come loose and flow into the brain, which could cause a stroke.
Two patients — a 71-year-old woman with diabetes and a 68-year-old man with emphysema — successfully underwent TCAR last month at Miami Cardiac and Vascular Institute – South Miami Hospital. One of the first two patients undergoing TCAR had the blood-reversal system in place for 14 minutes; the other for 8 minutes.
The TCAR team was led by vascular surgeons Juan Carlos Pereda, M.D., [2] Libby Watch, M.D. [3], and Steven Kang, M.D. [4], all with Miami Cardiac & Vascular Institute.
“What’s remarkable about TCAR is that patients tolerate this flow reversal extremely well,” says Dr. Pereda. “This procedure has the lowest amount of ‘hits’ to the brain of any of the other procedures, including traditional carotid artery surgery.”
TCAR is performed through a small incision at the neckline, just above the clavicle — instead of the more common stent placement that is initiated through the groin. TCAR eliminates the need to navigate catheters through the heart’s aortic arch, which creates a higher risk of stroke during carotid stenting through the groin.
“This is an important addition to services and patients of Miami Cardiac and Vascular Institute, as it provides a new and important tool in our approach to reducing stroke risk,” said Barry T. Katzen, M.D. [5], founder and chief medical executive of Miami Cardiac & Vascular Institute [6].
During flow reversal, the patient’s blood flows away from the brain and through the NPS (neuro-protection system), and any material is captured in a filter outside of the body.
“During carotid stenting, you have to manipulate the lesion (damaged section of the carotid artery) before you actually deploy protection with a stent,” explains Dr. Pereda. “In the TCAR procedure, we create blood flow reversal and maximize protection because any plaque that breaks off is not going to the brain — it’s getting sucked down into the filter within the NPS. You may see bits and pieces of plaque that are broken off during the procedure (in the NPS).”
Stroke is a potential complication of both traditional surgery — known as carotid endarterectomy, or CEA, and the most common stenting procedure through the groin – both to treat carotid artery disease. Dr. Pereda says that TCAR may represent up to half of procedures performed to treat carotid artery disease in the near future.
“I would characterize TCAR as a hybrid,” says Dr. Pereda. “It’s not the most minimally invasive because it’s not the type of small cut done in the groin. But it’s still minimally invasive because we’re not opening up the lesion itself (as in traditional surgery). TCAR only requires a small incision in the neck.”