INDIANAPOLIS — Close to 800,000 people in the United States will suffer a stroke this year.
High blood pressure is a leading cause, and placque found in the arteries running up to the brain poses a dangerous risk. Removing and stabilizing the placque can save a patient’s life, but old techniques are risky.
Now, doctors at Franciscan Health have a procedure they can offer their high risk patients called “TCAR” or transcarotid artery revascularization.
Dr. Thomas Webb is the director of vascular surgery at Franciscan Health.
“It’s essentially a vacuum cleaner during your procedure,” explained Dr. Webb. “So that any debris that’s dislodged during manipulation of the blood vessel is gained in the filtration system and not sent into the brain.”
In TCAR, an incision is made just above the collar bone and a sheath is placed through a puncture in the artery. That sheath will deliver a tiny metal stent to the area of the placque. But first, Dr. Webb reverses the blood flow away from the brain into a filter, so any loose debris is carried away. That reduces the risk of a stroke while the patient is undergoing the procedure.
“We put a one-way valve all the way into the artery and work through a bloodless plane. Then hook up through the vein into the groin or femeral vein and clamp and reverse the flow from the brain into a filtration circuit and back into the body,” said Dr. Webb.
The whole procedure takes just 10 to 15 minutes, which is safe. Studies have shown the brain can tolerate that amount of time without blood flow from the one artery because it’s fed by other arteries.
With improved imaging, Dr. Webb says most patients do very well.
“Imaging is fantastic now between CT angiography and ultrastenography, we’re working with detail down to the millimeter,” said Dr. Webb.
Patients are generally discharged 24 hours after the procedure.
Dr. Webb says the TCAR procedure is used only in high risk patients and has been approved by the FDA for five years.