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Safer, Less-Invasive Method to Repair Carotid Artery Blockage

Ann Keetch became one of the first patients to undergo a new procedure, transcarotid artery revascularization (TCAR) at Roper St. Francis in Charleston, South Carolina.

When Ann Keetch was at the dentist last year, her dentist spotted something severely wrong on an x-ray. After a trip to the emergency room, it was discovered that Keetch had severe plaque buildup in a carotid artery.

Carotid arteries carry blood to the head and neck. Since these arteries deliver blood to the brain, a blockage carries with it a high risk of stroke for the patient.

“Before 2018, the main treatment [for carotid artery disease] came with its own risk: If pieces of the clogged debris were displaced during the procedure and traveled to the brain, it could cause a stroke. Patients also faced long recovery times.” (The Post and Courier)

The most common procedure for a mild carotid artery blockage is a carotid endarterectomy (CEA). Plaque is removed through a large incision in the neck; the artery is then repaired, and the incision is closed.

A more severe blockage, like Keetch’s may need stenting. In stenting, an incision in made in the groin, where a catheter is put and guided through to the neck. Then, “a stent is placed that manually expands the artery to increase blood flow.” There is a slight chance that during this expansion, debris can break off and travel to the brain.

With the new TCAR procedure, a small incision is made at the neckline. Then a tube is place directly into the carotid artery. This tube is connected “to a system that will temporarily direct blood flow away from the brain, protecting against dangerous debris reaching the brain during the procedure.” A filter outside of the body will catch any debris traveling in the blood. The filtered blood is then returned through another tube in the upper thigh. A stent is placed to stabilize the plaque and prevent future strokes. Then the blood flow is reversed to its normal direction. (Carondelet Health Network)

“It allows us to treat patients who are sicker, with higher risk for complications, in a safer manner,” said Dr. Sean Hislop, a vascular surgeon at Roper St. Francis in Charleston, South Carolina.

Benefits of TCAR versus traditional CEA and/or stenting include:

  • A smaller incision, thus less scarring
  • Lower risk of stroke (1% versus 3%)
  • Prevents procedural stroke, since blood is reversed away from the brain
  • Minimal procedure time (7 minutes versus 45 minutes)

Elaine Newcomb has had both surgeries. In June of 2018, she had the traditional CEA in Myrtle Beach. She said she had to have staples to repair the huge incision, and it took three months to recover.

When an additional blockage was found in November, Newcomb was referred to The Medical University of South Carolina (MUSC) in Charleston. She said the recovery after TCAR surgery was only about 10 days. “It didn’t feel like major surgery to me,” she said.

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