TCAR
A comprehensive guide
How Is TCAR Different from Traditional Carotid Surgery?
TransCarotid Artery Revascularization (TCAR) is a newer, minimally invasive alternative to traditional carotid endarterectomy (CEA)—the open surgery used to treat carotid artery disease and reduce stroke risk. It offers enhanced neuroprotection while reducing procedural trauma.
Both TCAR and CEA aim to reduce the risk of stroke by clearing plaque buildup in the carotid arteries, but the way they achieve this and the risks and benefits they offer can differ significantly.
Neuroprotection: TCAR temporarily reverses blood flow in the carotid artery during plaque removal, helping prevent emboli from reaching the brain. This flow reversal is not used in open surgery.
Smaller Incision: TCAR uses a small incision just above the collarbone instead of a longer neck incision, reducing scarring and tissue disruption.
Anesthesia: Most TCAR procedures are performed under local anesthesia with light sedation, unlike traditional surgery which often requires general anesthesia—making TCAR safer for high-risk patients.
| Feature | TCAR (TransCarotid Artery Revascularization) | CEA (Carotid Endarterectomy) |
|---|---|---|
| Surgical Approach | Minimally invasive | Open surgery |
| Incision Location | Small (2–3 cm) above collarbone | Larger incision along the side of the neck |
| Neuroprotection | Blood flow reversal during plaque removal | No flow reversal; brain is more exposed to emboli |
| Anesthesia | Local anesthesia with sedation | Typically general anesthesia |
| Ideal for High-Risk Patients | Yes (especially elderly or with comorbidities) | Less ideal for high-risk patients |
| Hospital Stay | 1–2 days | 2–4 days |
| Recovery Time | 1–2 days | 2–4 days |
| Scarring & Discomfort | Minimal | More pronounced due to larger incision |
| Stroke Risk | Very low during procedure due to neuroprotection | Low but slightly higher risk due to embolic exposure |
Who’s a good candidate for TCAR?
TCAR is ideal for patients who are at higher surgical risk or have complex anatomy that makes traditional surgery less safe. This includes:
- Patients aged 75 and older
- Those with significant heart or lung disease
- Individuals who have undergone prior neck surgery or radiation
- Patients with a high carotid bifurcation, which is difficult to reach through traditional means
- Patients with soft or ulcerated plaque, which increases embolic risk
Your vascular surgeon will evaluate:
- Degree of stenosis (usually ≥70% narrowing for symptomatic cases, ≥80% for asymptomatic)
- Plaque characteristics on ultrasound or CTA/MRA
- Overall risk profile, including other health conditions and medications
The biggest innovation with TCAR lies in its ability to temporarily reverse blood flow in the carotid artery during the procedure. This means any plaque debris is directed away from the brain, dramatically reducing the risk of perioperative stroke—a key concern in carotid interventions.
In contrast, CEA requires clamping the artery and working directly on it with an open incision, which can carry a higher stroke risk if plaque breaks loose.
Additionally, the use of local anesthesia with TCAR reduces strain on the heart and lungs, which is important for elderly patients or those with cardiac and respiratory issues.
What is recovery like after TCAR?
Recovery from TCAR is typically faster and more comfortable than with traditional carotid surgery.
- Hospital Stay: Most patients go home within 1–2 days.
- Return to Activity: Light activity can often resume within a few days; full recovery usually takes 1–2 weeks.
- Stroke Risk Reduction: TCAR significantly lowers the risk of stroke both during and after the procedure. Many patients benefit from reduced complications compared to open surgery.
What are the risks of TCAR?
While TCAR is a safer and less invasive alternative, it’s still a vascular procedure and carries some risks. These include:
- Stroke – the risk is low, especially due to the flow reversal system, but it remains the primary concern
- Hematoma – bleeding or bruising at the incision siteM
- Nerve injury – rare and usually temporary; may affect voice or swallowing
- Allergic reaction – to contrast dye or medications used
- Infection – uncommon due to small incision, but still a possible complication
Your surgical team will provide detailed pre-procedure counseling, imaging review, and risk assessment to help you make an informed decision. You’ll also receive written educational materials and a chance to ask questions during your preoperative visit.
What should I look for in a TCAR treatment centre?
TCAR is a highly specialized procedure, and outcomes depend significantly on the experience and capability of the medical team.
Look for:
- Board-certified vascular surgeons with specific training in TCAR
- A team experienced in neurovascular intervention and stroke prevention
- Access to advanced imaging and intraoperative monitoring
- Accredited surgical facilities that meet strict infection control and quality standards
- A commitment to personalized treatment planning, not one-size-fits-all care
RIVEA Vascular Institute for TCAR
At RIVEA Vascular Institute, your TCAR procedure is led by Dr. Karthik Mikkineni, a former Stanford faculty member and an American board-certified vascular surgeon with extensive experience in advanced carotid interventions. As a national proctor for TCAR and the first to perform the procedure in India, Dr. Mikkineni brings unmatched expertise to every case.