Transcarotid Artery Revascularization (TCAR) may be recommended in the following situations:

• Diagnosis of carotid artery disease (CAD) has been confirmed.
• Considered high risk for traditional open surgery, such as carotid endarterectomy, due to factors like advanced age, anatomical challenges, or significant cardiac or pulmonary conditions.

Screening may be advised when the following risk factors are present:

• High blood pressure
• Diabetes
• Obesity
• Smoking history
• Presence of vascular disease in other parts of the body

Immediate medical attention is critical if any stroke warning signs appear, including:

• Sudden vision loss or difficulty seeing
• Sudden difficulty speaking or understanding speech
• Sudden numbness or weakness in the face, arm, or leg, especially on one side
• Sudden dizziness, loss of balance, or trouble walking
• Sudden severe headache with no known cause

Before a Transcarotid Artery Revascularization (TCAR) procedure, the healthcare team provides detailed guidance to support proper preparation. A meeting with the vascular surgeon is arranged to explain the procedure, address any concerns, and share essential preoperative instructions.

In the days leading up to the procedure, tests such as carotid artery ultrasound, CT angiography, or blood work may be performed to assess the condition thoroughly. Medication use and any known allergies are reviewed carefully.

The patient may be advised to start taking aspirin, blood thinners, or statins, while adjustments to current treatments might also be necessary.

Patients are typically instructed to avoid eating or drinking after midnight before surgery. Following all preparation guidelines is crucial for a safe and successful procedure.

TCAR is a minimally invasive procedure performed in a hospital operating room and typically takes under an hour. Here's what to expect during the procedure:

• Anesthesia is administered: either local (the patient is awake but relaxed) or general (the patient is fully asleep), based on the procedure's requirements.
• A small incision is made just above the collarbone to access the carotid artery.
• A tube is inserted into the artery and connected to a system that temporarily reverses blood flow, diverting plaque away from the brain and filtering the blood.
• Filtered blood is returned through another tube in the thigh or groin area.
• A stent is placed inside the narrowed artery to improve blood flow.
• Once the stent is in place, blood flow is restored, and the incision is closed with absorbable stitches. Post-procedure, bandages are applied, typically removed within 24 hours.

TCAR uses blood flow reversal and a plaque-stabilization technique rather than removing plaque, making it a safer, less invasive alternative to traditional surgery.

After the Procedure:

The care team will give the patient detailed instructions about activity, diet, medications, and follow-up care before discharge.

• Hospital Stay: Usually one overnight stay. Recovery is usually quick, with minimal pain and scarring compared to traditional surgery.
• Activity: Avoid strenuous activities like heavy lifting, as well as biking, or using hot tubs for at least a week. Avoid driving for the first 24 hours. Light activities like walking are recommended for a few days.
• Medications: Follow prescribed blood thinner regimen to help prevent blood clots in the newly opened artery. It’s important to take these exactly as directed.
• Incision Care: Remove dressings 24 hours after the procedure and leave the areas open to air. To clean incision sites, gently wash with soap and water. Pat dry with a clean towel—do not rub. Monitor for signs of infection
• What to Watch For: Contacting a doctor is necessary if there is unusual swelling, oozing, leg numbness, or changes in speech or vision. Follow-up care and maintaining a heart-healthy lifestyle are crucial for recovery.

An ultrasound will be scheduled at a later date to check the stented artery for any signs of narrowing (restenosis).

Like all types of carotid revascularization, TCAR carries some risks. While TCAR is designed to lower the chance of stroke during treatment, it is still important to be aware of possible complications. Possible risks include:

• Stroke
• Heart attack
• Carotid artery or cranial nerve damage
• Bleeding or swelling at the incision site

The care team will discuss these risks with the patient and take every precaution to ensure safety throughout the procedure and recovery.