CAROTID ARTERY DISEASE
Carotid artery disease is a form of atherosclerosis, or a build-up of plaque in one or both of the main arteries of the neck. The carotid arteries are vital as they feed oxygen-rich blood to the brain. When plaque builds up in the carotid arteries, they begin to narrow and slow down blood flow, potentially causing a stroke if blood flow stops or plaque fragments travel to the brain.
STROKE
Every year, 15 million people worldwide suffer a stroke, also known as a brain attack. Nearly 6 million die and another 5 million are left permanently disabled. Carotid artery disease is estimated to be the source of stroke in up to a third of cases, with 427,000 new diagnoses of the disease made every year in the United States alone.
STROKE
Every year, 15 million people worldwide suffer a stroke, also known as a brain attack. Nearly 6 million die and another 5 million are left permanently disabled. Carotid artery disease is estimated to be the source of stroke in up to a third of cases, with 427,000 new diagnoses of the disease made every year in the United States alone.
DIAGNOSIS
Carotid artery disease is typically silent and does not present with symptoms. Physicians can screen patients based on risk factors like high blood pressure, diabetes, obesity and smoking. Sometimes, patients are screened for carotid artery disease if the doctor knows the patient has vascular disease elsewhere in the body. Blockages can also be found when a physician hears a sound through a stethoscope placed on the neck. The sound is caused by blood flowing past the blockage.
If someone is having stroke-like symptoms (weakness/numbness on one side, loss of eyesight/speech, garbled speech, dizziness or fainting), they should seek immediate medical attention and be evaluated for carotid artery disease.
TESTS
Carotid artery ultrasound: This test uses sound waves that produce an image of the carotid arteries on a TV screen, and can be helpful in identifying narrowing in the carotid arteries. This test is painless and does not require the use of needles, dye or X-rays.
Angiography: An angiogram uses X-rays to take a picture of the carotid artery. In order for the X-ray to “see” the arteries, a dye is injected through a small tube (catheter) inserted into an artery in the groin or arm. This procedure will determine exactly where the narrowing is located and will help to guide further treatments.
If carotid disease is diagnosed during one of these tests, a doctor will discuss treatment options.
TRADITIONAL TREATMENT OPTIONS
Treatment options for carotid artery disease depend upon the severity of the overall patient condition and symptoms. Moderate disease may not require an interventional procedure, as some individuals can manage the disease with medications and lifestyle changes. More severe blockages may require surgery.
These treatment options have been shown to effectively treat the blockage; however, both options have limitations and carry a risk of stroke during the procedures themselves.
SURGICAL APPROACHES
Carotid Endarterectomy (CEA): This open surgical procedure removes plaque from inside the carotid artery in order to restore normal blood flow to the brain. The surgeon makes an incision on the neck to access the affected artery, opens the artery and removes the plaque. The surgeon will then close the artery and the incision in the neck using stitches.
Transfemoral Carotid Artery Stenting: In this minimally invasive alternative procedure, the physician works through a tube inserted into the artery in the upper thigh. First, a small umbrella-like filter is placed beyond the diseased area of the carotid artery to help limit fragments of plaque from traveling toward the brain during the procedure. The physician then inserts a slender, metal-mesh tube, called a stent, which expands inside the carotid artery to increase blood flow to the brain and stabilize the plaque.
A New Treatment Approach
TRANSCAROTID ARTERY REVASCULARIZATION (TCAR)
TransCarotid Artery Revascularization (TCAR) is a hybrid procedure that was developed to treat patients with carotid artery disease who are at risk for open surgery.
- The entire TCAR procedure is performed through a smaller incision in the neck and in less than half the time of a carotid endarterectomy – limiting the stress on the heart and significantly cutting the risk of the patient having a stroke or heart attack during the procedure.
- During the TCAR procedure, a tube inserted into the carotid artery is connected to a system that temporarily directs blood flow away from the brain to protect against dangerous debris from reaching the brain and causing a stroke during the procedure. Surgeons filter the blood before returning it to a vein in the groin, and a stent is implanted to the carotid artery to stabilize plaque and help prevent future strokes.
- Patients who undergo the TCAR procedure recover quickly and almost always go home the next day to return to full and productive lives with less pain and smaller scars than traditional treatments, and a reduced risk of future strokes.
- Over 10,000 procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent.
DIAGNOSIS
Carotid artery disease is typically silent and does not present with symptoms. Physicians can screen patients based on risk factors like high blood pressure, diabetes, obesity and smoking. Sometimes, patients are screened for carotid artery disease if the doctor knows the patient has vascular disease elsewhere in the body. Blockages can also be found when a physician hears a sound through a stethoscope placed on the neck. The sound is caused by blood flowing past the blockage.
If someone is having stroke-like symptoms (weakness/numbness on one side, loss of eyesight/speech, garbled speech, dizziness or fainting), they should seek immediate medical attention and be evaluated for carotid artery disease.
TESTS
Carotid artery ultrasound: This test uses sound waves that produce an image of the carotid arteries on a TV screen, and can be helpful in identifying narrowing in the carotid arteries. This test is painless and does not require the use of needles, dye or X-rays.
Angiography: An angiogram uses X-rays to take a picture of the carotid artery. In order for the X-ray to “see” the arteries, a dye is injected through a small tube (catheter) inserted into an artery in the groin or arm. This procedure will determine exactly where the narrowing is located and will help to guide further treatments.
If carotid disease is diagnosed during one of these tests, a doctor will discuss treatment options.
TRADITIONAL TREATMENT OPTIONS
Treatment options for carotid artery disease depend upon the severity of the overall patient condition and symptoms. Moderate disease may not require an interventional procedure, as some individuals can manage the disease with medications and lifestyle changes. More severe blockages may require surgery.
These treatment options have been shown to effectively treat the blockage; however, both options have limitations and carry a risk of stroke during the procedures themselves.
SURGICAL APPROACHES
Carotid Endarterectomy (CEA): This open surgical procedure removes plaque from inside the carotid artery in order to restore normal blood flow to the brain. The surgeon makes an incision on the neck to access the affected artery, opens the artery and removes the plaque. The surgeon will then close the artery and the incision in the neck using stitches.
Transfemoral Carotid Artery Stenting: In this minimally invasive alternative procedure, the physician works through a tube inserted into the artery in the upper thigh. First, a small umbrella-like filter is placed beyond the diseased area of the carotid artery to help limit fragments of plaque from traveling toward the brain during the procedure. The physician then inserts a slender, metal-mesh tube, called a stent, which expands inside the carotid artery to increase blood flow to the brain and stabilize the plaque.
A New Treatment Approach
TRANSCAROTID ARTERY REVASCULARIZATION (TCAR)
TransCarotid Artery Revascularization (TCAR) is a hybrid procedure that was developed to treat patients with carotid artery disease who are at risk for open surgery.
- The entire TCAR procedure is performed through a smaller incision in the neck and in less than half the time of a carotid endarterectomy – limiting the stress on the heart and significantly cutting the risk of the patient having a stroke or heart attack during the procedure.
- During the TCAR procedure, a tube inserted into the carotid artery is connected to a system that temporarily directs blood flow away from the brain to protect against dangerous debris from reaching the brain and causing a stroke during the procedure. Surgeons filter the blood before returning it to a vein in the groin, and a stent is implanted to the carotid artery to stabilize plaque and help prevent future strokes.
- Patients who undergo the TCAR procedure recover quickly and almost always go home the next day to return to full and productive lives with less pain and smaller scars than traditional treatments, and a reduced risk of future strokes.
- Over 10,000 procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent.
FREQUENTLY ASKED QUESTIONS
TCAR has been clinically proven as a less-invasive alternative to carotid endarterectomy, a traditional open surgery performed to treat carotid artery disease. What’s unique about TCAR is it temporarily reverses the blood flow during the procedure, so that any small bits of plaque that may break off during the procedure are diverted away from the brain, preventing a stroke from happening. A stent is then placed inside the artery to stabilize the plaque, minimizing the risk of a future stroke.
TCAR has a very low procedural stroke rate. It is also less invasive than open surgery, so there’s less chance for surgical complications like heart attacks, infection and nerve injury. TCAR patients also recover quickly and almost always go home the next day with less pain and smaller scars.
Over 10,000 TCAR procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent. In fact, the data are so compelling that the Society of Vascular Surgeons, Centers for Medicare and Medicaid Services (CMS), and the U.S. Food and Drug Administration (FDA) came together in September 2016 to create a program to support its reimbursement.
TCAR is recommended for patients who are considered high risk for traditional surgery due to age, anatomic issues and other medical conditions. A physician will determine if the TCAR procedure is right for a patient on a case-by-case basis based on his/her medical history and workup.
A small incision is made at the base of the neck, just above the collarbone. A puncture is made into the carotid artery and a small tube is placed inside the artery, which is connected to the system that temporarily directs blood flow away from the brain and captures any dangerous debris that dislodges from the artery. The blood is then filtered and returned to a vein through a second tube placed in the groin. While the brain is protected during this temporary flow reversal, a stent is placed in the carotid artery to stabilize the plaque and is intended to help prevent against future stroke. The blood flow is then returned to normal and the system is removed.
The entire procedure usually takes less than an hour. Patients can be either asleep or awake during the TCAR procedure and patients are typically held overnight for observation.
It’s rarely a problem because the brain has multiple arteries that supply it with blood. In addition, the critical part of the procedure, when the blood flow is reversed, only lasts about 10 minutes.
Vascular surgeons Dr. David Chang and Dr. Enrique Criado came up with the idea separately, but around the same time in 2004. Silk Road Medical, Inc. based in California has worked over the past 10+ years with the vascular surgery community in refining the procedure, conducting clinical trials, and are now commercializing TCAR in the U.S.