By Russell Becker, DO
Carotid artery disease affects millions of Americans, occurring when the major arteries in the neck become narrowed or blocked by plaque buildup. This condition significantly increases the risk of stroke, making early detection and treatment crucial for patient outcomes. While traditional treatment options have helped countless patients, a groundbreaking minimally invasive procedure called Trans Carotid Artery Stenting (TCAR) is revolutionizing how vascular specialists approach carotid disease treatment.
Understanding Carotid Disease
The carotid arteries are two large blood vessels that supply oxygen-rich blood to the brain. When these arteries become narrowed due to atherosclerosis—a buildup of fatty deposits, cholesterol, and other substances—blood flow to the brain becomes restricted. This condition, known as carotid artery stenosis, can lead to transient ischemic attacks (TIAs) or full strokes if left untreated.
Carotid disease develops gradually over years, often beginning with minor plaque deposits that progressively worsen. As the artery narrows, the brain receives less oxygen and nutrients, potentially causing cognitive impairment, dizziness, or weakness. In severe cases, plaque can rupture, forming blood clots that block blood flow entirely or break off and travel to smaller brain vessels, causing immediate stroke.
Common risk factors for carotid disease include advanced age, diabetes, high blood pressure, smoking, high cholesterol, and family history of cardiovascular disease. Lifestyle factors such as sedentary behavior, poor diet, and chronic stress also contribute to disease progression. Many patients experience no symptoms until the condition becomes severe, which is why regular screening is essential for those at risk. Warning signs may include sudden weakness, speech difficulties, vision problems, or severe headaches.
Traditional Treatment Approaches
Historically, patients with significant carotid artery stenosis had two primary treatment options: carotid endarterectomy (CEA) and carotid artery stenting (CAS). CEA involves surgically opening the artery and removing the plaque, while traditional CAS uses a stent placed through a catheter inserted in the groin and threaded up to the carotid artery.
While both procedures have proven effective, they each carry certain risks and limitations. CEA requires general anesthesia and leaves patients with a neck incision, while traditional CAS carries the risk of dislodging plaque particles that could travel to the brain during the procedure.
The TCAR Advantage
Trans Carotid Artery Stenting represents a significant advancement in carotid intervention. This innovative procedure combines the benefits of both traditional approaches while minimizing their respective risks. TCAR involves making a small incision directly over the carotid artery in the neck, similar to CEA, but instead of surgically removing the plaque, a stent is placed to open the blocked artery.
The key innovation of TCAR lies in its unique flow reversal system. During the procedure, blood flow is temporarily reversed away from the brain, ensuring that any debris dislodged during stent placement is captured and removed from the body rather than traveling to the brain. This dramatically reduces the risk of stroke during the procedure.
The TCAR system consists of three main components: a sheath placed directly into the carotid artery, tubing that connects to a filter system, and the stent delivery system. When activated, the flow reversal creates a protective barrier, allowing surgeons to work safely while maintaining optimal brain protection. This technology represents years of research and development, specifically designed to address the limitations of previous carotid interventions.
Benefits of TCAR
TCAR offers numerous advantages over traditional treatment methods. The procedure can often be performed under local anesthesia with conscious sedation, reducing risks associated with general anesthesia. Recovery time is typically shorter than with CEA, and the risk of cranial nerve injury is virtually eliminated since the procedure doesn’t require extensive surgical dissection.
The flow reversal technology provides superior brain protection compared to traditional carotid stenting, making TCAR suitable for high-risk patients who might not be candidates for other procedures. Additionally, the direct access approach eliminates the need to navigate through potentially diseased arteries in the chest and abdomen, reducing procedural complexity.
Patient Selection and Outcomes
TCAR is particularly beneficial for patients considered high-risk for traditional surgery due to factors such as advanced age, heart disease, previous neck surgery, or radiation therapy. The procedure is also ideal for patients with challenging anatomy, including high bifurcations, short necks, or tortuous vessels that make traditional approaches more difficult.
Clinical studies have demonstrated excellent outcomes with TCAR, showing low rates of stroke, death, and myocardial infarction. Real-world data continues to support these findings, with many patients experiencing immediate symptom relief and improved quality of life. The procedure’s success rate exceeds 95% in most studies, with complications occurring in less than 3% of cases.
Long-term follow-up data shows excellent stent patency rates, meaning the treated arteries remain open and functional years after the procedure. Patients typically return to normal activities within days rather than weeks, and the smaller incision results in minimal scarring and reduced post-operative discomfort.
Take Action for Your Vascular Health
If you or a loved one has been diagnosed with carotid disease or are experiencing symptoms that could indicate vascular problems, don’t wait to seek expert care. The specialists at Vascular Center of Naples are experienced in the latest treatment options, including TCAR, and can help determine the best approach for your specific condition. Call 239-431-5884 today to schedule a consultation and take the first step toward protecting your vascular health.
1875 Veterans Park Dr. Suite 2203
Naples, FL 34109
239-431-5884
www.VascularCenterNaples.com