Transcarotid artery revascularization (TCAR) is a minimally invasive procedure to open narrowed or blocked arteries leading to the brain. Compared with other procedures for carotid artery disease, TCAR greatly reduces the risk of a stroke during and after the procedure, if you’re at high risk.
At Penn Medicine Lancaster General Health, our vascular surgeons are the first in Lancaster County to offer TCAR. This procedure combines open surgery with an endovascular procedure (treatment inside blood vessels). TCAR is safe, effective treatment for moderate to severe carotid artery disease.
What Is Transcarotid Artery Revascularization (TCAR)?
Transcarotid artery revascularization (TCAR) is a vascular procedure that combines minimally invasive and open surgical approaches to open the carotid artery. This artery is one of a pair of arteries in the front of the neck that carries blood to the brain.
TCAR treats carotid artery disease, a buildup of cholesterol and other fatty substances (plaque) inside the artery. Carotid artery disease can cause narrowing or a blockage in a carotid artery, which slows blood flow to the brain and can cause a stroke.
As a hybrid procedure, TCAR is less invasive than open surgery, but it preserves the safeguards of the open procedure. Compared with open and minimally invasive procedures to treat carotid artery disease, TCAR offers benefits such as:
- Easier recovery: TCAR involves a smaller incision in the neck, less pain, a shorter hospital stay and less recovery time than open surgery (carotid endarterectomy).
- Lower risk of stroke: In TCAR, the surgeon temporarily reverses the carotid artery’s blood flow away from the brain, unlike the minimally invasive procedure (carotid angioplasty and stenting). This step prevents any plaque that comes loose during the procedure from going to the brain. Even with the reversed blood flow, the brain receives enough blood and oxygen through the other carotid artery.
TCAR provides a safe, effective treatment option if you:
- Are at a high risk of complications after carotid endarterectomy because of your age or other medical conditions
- Have moderate to severe carotid artery disease, which requires treatment with a procedure rather than medication
TCAR: The Penn Medicine Lancaster General Health Advantage
Our vascular team specializes in minimally invasive procedures and traditional, open surgery for carotid artery disease. We carefully evaluate you and help you decide on the right treatment option for you. We offer:
- Expertise in endovascular procedures: Our board-certified vascular surgeons have additional years of training in vascular surgery and endovascular (minimally invasive) procedures. We’ve developed extensive experience in TCAR by performing a high number of these procedures each year.
- Team approach: We bring together experienced specialists from vascular surgery, vascular medicine, interventional radiology and other fields. We work together to evaluate you, understand your unique health needs and determine the right treatment for you.
- Active in research: One of our surgeons is leading a national clinical trial that explores the benefits of TCAR for low-risk patients, offering access to this treatment for people who qualify. Our doctors have participated in previous research trials, after which the Food and Drug Administration approved TCAR for high- and moderate-risk patients. You can feel confident that your doctors are bringing the latest advances in clinical research directly to your care.
- Nationally recognized vascular imaging: Our vascular lab has earned accreditation from the Intersocietal Accreditation Commission for our high standards in patient care. Our technicians are registered vascular technologists who have certifications in vascular technology and specialize in vascular imaging.
- Commitment to improving your care: LG Health is the only hospital in Lancaster County and one of few in the region that reports our patient outcomes to national registries. We continually measure our results against national outcomes to find ways to improve care for you.
What to Expect During Transcarotid Artery Revascularization (TCAR)
Before the TCAR procedure, your vascular surgeon will meet with you and explain the procedure, provide instructions for how to prepare and answer your questions. You might need imaging or other tests done a few days before the procedure.
The TCAR procedure itself takes less than one hour. You will receive either general anesthesia, which is like being asleep, or local anesthesia with moderate sedation to help you relax. To begin the procedure, the surgeon will:
- Make a small incision in your neck to access your carotid artery.
- Place a sheath (thin, flexible tube) in the artery to connect it to a system that reverses blood flow. The system filters any plaque from the blood and sends the blood back into your body through a vein in your upper thigh.
- Insert a catheter with a tiny balloon at its tip into the carotid artery and guides it to the narrowed area.
- Inflate the balloon to press the plaque against the artery walls to open it for better blood flow.
- Place a stent (tiny, metal mesh tube) inside the artery to keep it open.
- Remove the sheath to restore blood flow to the brain, then close the artery and neck incision.
Your recovery begins in the recovery room, where a nurse will monitor your vital signs and alertness as you wake up. Once you’re stable, we’ll take you to either the intensive care unit or your hospital room. You can expect to a hospital stay of one night.
Before you leave the hospital, your care team will give you instructions for at-home care. Your overall recovery lasts about one week after the procedure. You’ll come back for your first follow-up visit about four to six weeks after the procedure.
Make an Appointment
To schedule a TCAR consultation, call 717-544-3626.