Plaque buildup in the main artery to the brain presents a dilemma for surgeons. Surgically opening up the artery to clear the blockage is the most direct solution, but when the artery is unclamped, there is a small risk that debris can be released into the bloodstream and cause a stroke.
Inserting a stent to open up the artery is a minimally invasive alternative, but also can pose a risk of embolic stroke when the stent is inserted into the femoral artery and guided through the bloodstream to the neck.
Sung Wan Ham, MD, assistant professor of clinical surgery at the Keck School of Medicine of USC, has undergone special training to offer a new minimally invasive technique called transcarotid artery revascularization (TCAR). The procedure reduces the risk of stroke with a device that reverses the flow of blood away from the brain and filters out plaque debris from the bloodstream.
“Carotid artery endarterectomy and conventional carotid stenting are both safe and effective ways to treat carotid artery occlusive disease,” Ham said. “But TCAR is a hybrid of both procedures that is minimally invasive and a potentially safer alternative for select patients.”
One of the device’s catheters is inserted into the carotid artery and a second goes into the femoral vein in the groin. Because the pressure in the artery is greater than that in the vein, the flow of blood temporarily reverses during the placement of the stent. Any debris is carried away from the brain and captured by the device’s filter. The 30-day risk of stroke is only 1.4 percent, compared to 4.1 percent for a traditional stenting procedure, Ham said, citing studies of this new procedure.
Surgeons must be trained and certified by the manufacturer in order to use the device, so the TCAR procedure is not widely available. Ham noted that by having another option available for treating carotid artery plaque, each patient could be matched with a safe procedure that best suits their individual needs.
— Lex Davis