Stroke is the leading cause of long-term disability and third leading cause of death in the United States, with 20-30% of ischemic strokes caused by carotid artery disease. Although carotid endarterectomy has been performed for over 50 years, there remains an inherent risk of perioperative stroke and cardiac mortality. Transcarotid artery revascularization (TCAR) is a novel method in the surgical management of carotid disease, where blood flow in the common carotid artery is temporary reversed away from the brain to confer protection from intraoperative stroke. Recent investigational studies reveal a 1.1% risk of perioperative stroke and 0% cardiac mortality. Described herein is a case series of the first four TCAR procedures performed in the South Florida region.
The procedures were performed by creating an incision over the common carotid artery, which was dissected free and controlled. The contralateral femoral vein was then accessed percutaneously. The common carotid artery was then punctured under direct visualization and the ENROUTE Transcarotid Neuroprotection System® was then connected between carotid artery and femoral vein to reverse flow through the carotid artery. Balloon angioplasty and stenting of the internal carotid artery was then performed.
Of the four TCAR procedures performed, three were for symptomatic and one for asymptomatic high-grade carotid artery stenosis. There was no incidence of peri-operative stroke or mortality. Three of the patients were discharged on post-operative day one, one on post-operative day three due to adrenal insufficiency.
Transcarotid Artery Revascularization (TCAR) represents the next step in minimally invasive surgical management of high-risk patients with severe carotid artery disease. The above cases represent a single institution experience with the first TCAR procedures to be performed in South Florida.