What is TransCarotid Artery Revascularization or TCAR?
TCAR has been clinically proven as a less-invasive alternative to carotid endarterectomy, a traditional open surgery performed to treat carotid artery disease. What's unique about TCAR is it temporarily reverses the blood flow during the procedure, so that any small bits of plaque that may break off during the procedure are diverted away from the brain, preventing a stroke from happening. A stent is then placed inside the artery to stabilize the plaque, minimizing the risk of a future stroke.

How is TCAR better for patients?
TCAR has a very low procedural stroke rate. It is also less invasive than open surgery, so there's less chance for surgical complications like heart attacks, infection and nerve injury. TCAR patients also recover quickly and almost always go home the next day with less pain and smaller scars.

How safe is TCAR?
Over 10,000 TCAR procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent. In fact, the data are so compelling that the Society of Vascular Surgeons, Centers for Medicare and Medicaid Services (CMS), and the U.S. Food and Drug Administration (FDA) came together in September 2016 to create a program to support its reimbursement. In May 2022, the FDA approved expanded use of TCAR for patients of average surgical risk. 

Who should be considered for the TCAR procedure?
TCAR is recommended for patients who are considered average or high risk for traditional surgery due to age, anatomic issues and other medical conditions. A physician will determine if the TCAR procedure is right for a patient on a case-by-case basis based on his/her medical history and workup.

What happens during a TCAR procedure?
A small incision is made at the base of the neck, just above the collarbone. A puncture is made into the carotid artery and a small tube is placed inside the artery, which is connected to the system that temporarily directs blood flow away from the brain and captures any dangerous debris that dislodges from the artery. The blood is then filtered and returned to a vein through a second tube placed in the groin. While the brain is protected during this temporary flow reversal, a stent is placed in the carotid artery to stabilize the plaque and is intended to help prevent against future stroke. The blood flow is then returned to normal and the system is removed.

The entire procedure usually takes less than an hour. Patients can be either asleep or awake during the TCAR procedure and patients are typically held overnight for observation.

Is it ever a problem that the blood is being diverted away from the brain?
It's rarely a problem because the brain has multiple arteries that supply it with blood. In addition, the critical part of the procedure, when the blood flow is reversed, only lasts about 10 minutes.

The TCAR procedure was developed by Sunnyvale, California-based Silk Road Medical, Inc. and includes the ENROUTE® Transcarotid Neuroprotection (NPS) and Stent System - the first devices designed and FDA-approved specifically for TCAR. Over 10,000 TCAR procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent. Additional information about TCAR is available at https://silkroadmed.com/patient-caregivers/.

Sources:
https://silkroadmed.com/disease-and-treatment-options