Minimally Invasive Approach to Treat Carotid Artery Disease

Carotid arteries are blood vessels in the neck that deliver oxygen-rich blood to the brain. Carotid artery disease occurs when the carotid arteries become clogged with fatty material called plaque. When plaque builds up in the carotid arteries, they begin to narrow and slow down blood flow, potentially causing a transient ischemic attack (TIA), or stroke, if blood flow stops or plaque fragments travel to the brain.

Treatment options for carotid artery disease depend on the severity of the condition and symptoms. Coronary artery disease may be managed by taking antiplatelets, cholesterol, and blood pressure medications, or making lifestyle changes. Severe blockages, however, may require surgery.

“While carotid endarterectomy (CEA) is considered the gold standard treatment for severe carotid artery disease, there is a growing number of high-risk patients who are not eligible for this more invasive surgery,” explains Vahram Ornekian MD, cardiothoracic surgeon at PIH Health. CEA involves making an incision on the side of the neck over the affected artery that may lead to complications in patients at risk for an open surgical procedure.

Transcarotid artery revascularization (TCAR) is a minimally invasive approach to treat carotid artery disease. The procedure begins with a small incision just above the collarbone to allow access to the carotid artery. A short hollow tube (sheath) is placed in the carotid artery. To protect the brain from plaque debris during the procedure, a circuit outside the body directs the blood flow away from the brain, collecting any potential debris in the device filter, before returning the blood safely back into a vein in the leg. This “reverse flow” allows the physician to place a stent (an expandable mesh tube) at the site of the disease for long-term plaque stabilization and stroke prevention. The entire procedure usually takes less than an hour. Patients can be either asleep or awake during the TCAR procedure and are typically held overnight for observation. TCAR is well suited for patients who are higher risk of surgical complications due to age, pre-existing conditions, or anatomical issues.

“This innovative approach offers a viable, less invasive treatment alternative for high-risk patients,” says Dr. Ornekian.

For more information about the Transcarotid Artery Revascularization procedure, go to PIHHealth.org/VascularCare.