Outcomes of TransCarotid Artery Revascularization (TCAR): A Systematic Review by Felix Hospitals

Transcarotid Artery Revascularization (TCAR) is a novel and increasingly popular procedure aimed at preventing strokes in patients with carotid artery disease. Carotid artery disease occurs when plaque builds up inside the carotid arteries, narrowing them and reducing blood flow to the brain, which increases the risk of ischemic stroke. Traditionally, carotid endarterectomy (CEA) has been the gold standard for treating carotid artery stenosis. However, TCAR has emerged as a less invasive alternative to CEA, offering certain advantages in select patient populations. For those seeking the Best Hospital for Carotid Artery Surgery, TCAR at Felix Hospitals stands out as a cutting-edge solution, combining advanced technology with exceptional patient care to ensure optimal outcomes.

Ready to Learn More About TCAR? Contact Felix Hospitals Now at +91 9667064100.

What Is TransCarotid Artery Revascularization (TCAR)?

TCAR is a minimally invasive procedure designed to reduce the risk of stroke in patients with carotid artery disease. It combines aspects of open surgery and endovascular techniques, which allows for a more direct and safer route to reach and treat the carotid artery. TCAR involves placing a stent in the carotid artery to open up the narrowed passage and improve blood flow to the brain.

The TCAR Procedure:

1. Incision and Access: A small incision is made just above the clavicle to access the common carotid artery. Unlike CEA, which requires a larger incision and involves direct removal of plaque, TCAR uses an endovascular approach.
  
2. Flow Reversal: A crucial feature of TCAR is the temporary reversal of blood flow in the carotid artery during the procedure. This protects the brain from any plaque debris dislodged during the stenting process by diverting the debris away from the brain and into a filter outside the body.
 

3. Stent Placement: After flow reversal is established, a stent is placed in the carotid artery to widen it, allowing for better blood flow to the brain and reducing stroke risk.
 

4. Completion and Recovery: The blood flow is returned to its normal direction after the stent is in place, and the patient is typically discharged within a day or two.

Clinical Outcomes of TCAR

1. Stroke Prevention

The primary goal of TCAR is to reduce the risk of stroke in patients with significant carotid artery stenosis. Multiple studies have demonstrated that TCAR has a low rate of perioperative stroke, which is one of the most critical metrics in assessing its success.
 

• Low Stroke Rates: Clinical trials, including the pivotal ROADSTER studies, showed stroke rates of less than 1.4% in patients undergoing TCAR. These numbers are highly competitive with, and in some cases superior to, traditional CEA and Carotid Artery Stenting (CAS) methods.

• Effective for High-Risk Patients: High-risk patients, such as those with advanced age, coronary artery disease, or prior neck surgery, have been shown to benefit significantly from TCAR. These patients are often considered poor candidates for CEA due to increased surgical risk. However, TCAR provides an effective stroke-preventing alternative with fewer complications.
   

2. Reduced Risk of Perioperative Complications

The less invasive nature of TCAR reduces the likelihood of complications commonly associated with open surgery like CEA. The small incision and shorter procedure time result in fewer surgical risks, such as cranial nerve injury, hematoma, or infection.
 

• Lower Risk of Cranial Nerve Injury: One of the complications associated with CEA is the potential for cranial nerve damage due to the extensive dissection around the neck area. This risk is significantly reduced in TCAR because of the minimally invasive nature of the procedure.

• Minimal Incision Complications: TCAR’s smaller incision translates to a reduced risk of infection and other wound-related complications. The procedure is also associated with less postoperative pain and faster healing times.

3. Improved Mortality Rates

TCAR has been shown to have comparable or better mortality rates when compared to CEA and CAS, particularly in high-risk patient populations. The ability to reverse blood flow during the procedure prevents debris from traveling to the brain, a critical aspect that reduces the risk of stroke and subsequent mortality during the operation.

4. Faster Recovery and Shorter Hospital Stay

One of the most significant advantages of TCAR is the shorter recovery time compared to CEA. Patients who undergo TCAR typically experience:
 

• Shorter Hospital Stays: Most TCAR patients are discharged within one or two days post-procedure. This is in stark contrast to the longer recovery periods associated with CEA.

• Quicker Return to Normal Activities: Patients usually return to their regular activities sooner after TCAR than after CEA, making it an attractive option for those seeking faster recovery.
  
   

5. Long-Term Outcomes

While the short-term outcomes of TCAR are promising, it is important to evaluate its long-term success in preventing recurrent strokes and maintaining arterial patency.

• Durability: Studies have indicated that TCAR offers durable protection against stroke in the long term, with low rates of restenosis (re-narrowing of the artery). Five-year follow-up data from ROADSTER trials suggest that the incidence of recurrent carotid artery stenosis is low, making TCAR a reliable choice for long-term stroke prevention.

• Reintervention Rates: TCAR shows a low reintervention rate, meaning that patients rarely need repeat procedures to maintain carotid artery patency. This is comparable to, if not better than, the rates seen in patients undergoing CEA or traditional stenting.

Comparison of TCAR with Other Treatment Modalities

1. TCAR vs. Carotid Endarterectomy (CEA)

Carotid endarterectomy is the conventional open surgical procedure for removing plaque buildup from the carotid artery. Although CEA remains the gold standard in some cases, TCAR offers several benefits: 
 

• Less Invasive: TCAR involves a much smaller incision compared to the larger neck incision needed for CEA. This results in lower complication rates related to wound healing and cranial nerve damage.

• Shorter Recovery: The recovery period after TCAR is generally shorter, with patients returning to their normal lives faster than those who undergo CEA.

• Fewer Surgical Risks: For patients who are at high risk for surgical complications due to comorbidities, TCAR provides a safer alternative. This is especially important for older patients or those with prior neck surgeries.

2. TCAR vs. Traditional Carotid Artery Stenting (CAS)

Carotid Artery Stenting (CAS) is another less invasive option that involves placing a stent in the carotid artery via a catheter inserted through the femoral artery in the groin. While CAS has been widely used, TCAR has several key advantages:
 

• Direct Access: Unlike CAS, where the stent is delivered through the femoral artery, TCAR accesses the carotid artery directly through a small incision near the clavicle. This reduces the risk of complications associated with navigating the stent through the entire length of the body.

• Flow Reversal: The temporary flow reversal technique in TCAR is a unique feature that protects the brain from stroke during the procedure by diverting debris away from the brain, which CAS does not offer.

• Lower Stroke Risk: Some studies suggest that TCAR has a lower risk of perioperative stroke compared to CAS, making it a more appealing choice for stroke prevention.

Future Directions and Innovations in TCAR

The field of TCAR is continuously evolving, with ongoing research aimed at refining the technique and expanding its applicability to broader patient populations. Some areas of future development include:
 

• Expanded Patient Eligibility: As the technology and experience with TCAR improve, it is expected that more patient groups, including those with more complex anatomy or comorbidities, will be eligible for the procedure.

• Refinement in Devices: Continued innovation in stent technology and flow reversal devices will likely further reduce the already low risk of complications associated with TCAR.

• Personalized Medicine: Advances in imaging and diagnostic techniques may allow for better patient selection, ensuring that those who are most likely to benefit from TCAR are accurately identified.
  
   

Meet the Best Vascular surgery treatment Specialist at Felix Hospital

Dr. Ritesh Agrawal, the best doctor for carotid arteries at Felix Hospital, brings years of expertise in performing advanced procedures like Transcarotid Artery Revascularization (TCAR). With a strong commitment to patient care and a focus on stroke prevention, Dr. Agrawal ensures that each patient receives personalized, minimally invasive treatment for carotid artery disease, aimed at achieving the best possible outcomes.

Protect Your Brain, Prevent Stroke – Choose TCAR at Felix Hospitals Today! Book your Appointment by Clicking Here.

Conclusion

Transcarotid Artery Revascularization (TCAR) represents a major advancement in the treatment of carotid artery disease. By combining the benefits of both open surgery and minimally invasive techniques, TCAR provides a safer, more effective option for many patients at risk of stroke. The outcomes of TCAR, particularly in terms of stroke prevention, reduced complications, and faster recovery times, make it a highly attractive alternative to both CEA and traditional carotid artery stenting.

In the future, as the procedure continues to evolve, we can expect even greater improvements in patient outcomes, further cementing TCAR’s role as a critical tool in stroke prevention. For now, TCAR offers a well-established, effective solution that promises both short-term safety and long-term durability for patients with carotid artery stenosis.

Frequently Asked Questions (FAQs)

1. What is TransCarotid Artery Revascularization (TCAR)?  

ANS: TCAR is a minimally invasive procedure used to treat carotid artery disease by placing a stent in the carotid artery, preventing strokes by improving blood flow to the brain.
 

2. How does TCAR reduce the risk of stroke?  

ANS: During TCAR, blood flow in the carotid artery is temporarily reversed to prevent plaque debris from reaching the brain while the stent is being placed, significantly lowering the risk of stroke.
 

3. Who is a good candidate for TCAR?  

ANS: TCAR is ideal for patients with carotid artery disease, especially those at high risk for traditional surgery due to factors like age, coronary artery disease, or prior neck surgeries.
 

4. How does TCAR compare to carotid endarterectomy (CEA)?  

ANS: Unlike CEA, which involves a larger incision and direct plaque removal, TCAR is less invasive, offers quicker recovery, and has fewer risks of complications, such as cranial nerve injury.

5. Is TCAR safer than traditional carotid artery stenting (CAS)?  

ANS: TCAR offers a safer approach by directly accessing the carotid artery through a small incision and using a flow reversal system to protect the brain from stroke during the procedure, a feature not available in CAS.

6. What is the recovery time for TCAR?  

ANS: Most patients undergoing TCAR can return home within 1 to 2 days and resume normal activities much sooner compared to those who undergo traditional carotid surgery.

7. Are there long-term benefits to TCAR?  

ANS: Yes, TCAR has shown excellent long-term outcomes with a low rate of restenosis (re-narrowing of the artery) and minimal need for reintervention, offering durable stroke prevention.

8. How do I know if TCAR is the right option for me?  

ANS: If you have Carotid Artery Disease, your doctor will evaluate your health history, anatomy, and risk factors to determine if TCAR is the best treatment option for you. Consult with our experts at Felix Hospitals to make an informed decision.