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Health & Wellness

TCAR: A minimally invasive option that reduces the risk of stroke for some patients

Carotid,Artery,Surgery,,Carotid,Endarterectomy,Procedure
Paradee Siriboon
/
Shutterstock
While open carotid artery surgery (above) remains the gold standard, TCAR uses a small incision and a catheter to deploy a stent.

A 2018 study determined stroke was the third-leading cause of death in Texas.

Carotid artery disease is a major cause of strokes. It narrows or blocks the arteries, on each side of your neck under the jawline, that provide the main blood supply to the brain.

Dr. Yinn Cher Ooi explains to KERA's Sam Baker why an advanced, minimally invasive procedure called transcarotid artery revascularization (TCAR) is a major step forward in treatment.

INTERVIEW HIGHLIGHTS:

About carotid artery disease

Carotid disease, unfortunately, affects a huge population in this country. Americans are not known for the healthiest lifestyle and diets, and we have an aging population, so the incidence of carotid artery disease is increasing as a result.

The number of strokes caused by carotid artery disease is also increasing, but the good news is there are very good treatment options out there. By adequately treating carotid disease, we can play a significant role in preventing the stroke burden in the community.

How can TCAR help?

TCAR stands for transcarotid artery revascularization.

Think of it as a hybrid surgery specifically designed to treat carotid disease in order to prevent strokes in the brain.

Traditionally, carotid artery disease is treated by conventional surgery: A big incision along the neck. Find, open and clean out the artery — all the debris, the calcium, the plaque deposit — and sew it all back up. That's a very delicate surgery that requires multiple days in the hospital and leaves a very visible scar.

Then came the minimally invasive, so-called endovascular procedure: You enter an artery in the thigh or the wrists, get a catheter all the way up to the neck, where we inflate a balloon to open the artery and keep that artery open with the stent.

With TCAR, a small incision just above the collarbone gains direct access to the carotid artery. We introduce a catheter to inflate a balloon to open up the artery and deploy a stent.

That gives very precise control and the lowest risk for any complication for any disease treatment out there.

TCAR Debris.JPG
Texas Health Fort Worth
A TCAR procedure performed by Dr. Ooi prevented debris from reaching the brain and causing a stroke.

Who’s eligible for carotid artery disease?

Open surgery is still the gold standard. We're using TCAR for people at high risk for surgery. The technology is still in its infancy, so there is a certain criterion of patients. Your carotid artery has to be long enough for us to be able to stick a catheter in it through the neck.

The irony about having major surgery for carotid artery disease is that people who have multiple comorbidities — severe diabetes, heart disease, uncontrolled hypertension — these are the people that are not going to do well with major surgery. Ironically, these are also the people who are likely to have carotid artery disease.

These are people that would be best served with a very minimally invasive procedure, such as TCAR. But the technology needs to mature. Not everyone out there is trained to do this quite yet.

What can individuals do on their own to minimize risk of stroke or carotid artery disease?

The bottom line is prevention:

  • A healthy lifestyle
  • A balanced diet
  • Avoid foods high in saturated fat
  • Exercise regularly
  • Follow up routinely with your primary care physician to make sure your blood pressure, cholesterol levels, and diabetes levels are well-controlled

These are all risk factors that I see time and time again, things that can be avoided.

Resources:

Texas Health Resources: Vascular Disease

Anatomic Eligibility for Transcarotid Artery Revascularization and Transfemoral Carotid Artery Stenting

Texas Stroke System of Care Report, 2018

Heart Disease and Stroke Programhttps://www.dshs.texas.gov/heart/default.aspx

Interview highlights were lightly edited for clarity.

Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.

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