New Carotid Procedure Lowers Stroke Risk and Recovery Time

An innovative carotid procedure known as TCAR reverses blood flow to reduce stroke risk during revascularization. It’s now being performed at Michigan Medicine.

7:00 AM

Author | Haley Otman

Gordon Ash was expecting to have his first major surgery this summer: a carotid endarterectomy to treat his narrowed carotid artery.

But when a CT scan showed the blockage in his artery was higher up in his neck than many other patients with carotid disease, Ash became the first person at Michigan Medicine to undergo a new procedure.

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily audio updates on iTunes, Google Play and Stitcher.

TCAR, which stands for transcarotid artery revascularization, uses a device from Silk Road Medical to briefly reverse the direction of blood flow. With blood (and any clots) flowing away from the brain while the physician operates, the patient's risk of stroke during the procedure is lower.

It's a technique developed by Enrique Criado, M.D., a former Michigan Medicine faculty member, and tested at Michigan Medicine during clinical trials. TCAR was recently approved by the Food and Drug Administration.

Now, vascular surgeons are performing non-trial cases at the University of Michigan Frankel Cardiovascular Center.

"This is a promising treatment and the stroke rates have been reported as low as 1.4 percent in trials," says Nicholas Osborne, M.D., Ash's surgeon and an assistant professor of surgery at U-M. "It's a safer carotid stent procedure than anything previously offered."

TCAR also offers patients a quicker recovery, he notes.

How TCAR works

Osborne describes TCAR as a hybrid of what's already available to treat a narrowed carotid artery, but with a twist.

First, the surgeon makes a small carotid exposure in the low neck. After reversing the blood flow away from the brain, the surgeon will directly stent from that position, avoiding the risks that come from traveling up from the femoral artery, the aorta and up to the carotid artery.

MORE FROM THE LAB: Subscribe to our weekly newsletter

When the stent is placed via TCAR, allowing the carotid artery to function normally, the blood flow reverses back to its regular direction toward the brain.

With TCAR, a patient's blood flow is briefly reversed to reduce the risk of stroke during carotid surgery.

The first report of the procedure was around 14 years ago, and the unique nature of the approach appealed to vascular surgeons. The general idea, though, is familiar.

"In open vascular surgery, it's not uncommon for us to let arteries back bleed to wash them out," Osborne says. "This was actively applying that open surgery technique to an endovascular procedure."

Another carotid treatment option

For Ash, the notion of receiving a new surgery was surprising at first.

"Initially, I had expected and wanted the standard endarterectomy procedure," the 62-year-old says. "But Dr. Osborne thought the TCAR was a better option for me, so I said, 'Well, that's what we're going to do.'"

Surgeons typically have recommended stenting or an endarterectomy to repair the carotid artery. Carotid stenting from the femoral artery comes with a higher risk of stroke, Osborne says, making it less commonly used. The wire and distal protection device can knock plaque off into the bloodstream during the procedure, causing a stroke as it ascends toward the brain.

In an endarterectomy, an open surgery with more recovery time, nerve injury risk is a greater concern. This was the case for Ash, as the higher location of blockage in his artery meant his sensory nerves, swallowing mechanism and nerves that control his tongue could have been damaged.

For this reason, Osborne and Ash decided to change their plans from an endarterectomy to the TCAR.

Matthew Corriere, M.D., also a vascular surgeon at the Frankel Cardiovascular Center, teamed up with Osborne during Ash's TCAR procedure. Corriere says he's excited about adding a third option for patients with carotid stenosis to lower their stroke risk.

"Being able to offer carotid endarterectomy, stenting or TCAR allows us to individualize the procedure choice based on the patient and their anatomy," says Corriere, also an associate professor of surgery.

Quick recovery and wide appeal

Roughly one day after his June procedure, Ash was already heading home.

Later that week, the Novi, Michigan, grandfather was back on baby-sitting duty with his three young grandchildren for a few days. And he returned to his job as a data center telecommunications designer the following week.

SEE ALSO: Setting a Trap to Treat Stroke

Ash says the recovery was manageable and notes that he only needed an over-the-counter pain medication for some discomfort right afterward.

The less invasive option of TCAR, coupled with its lower stroke rate, may be a better option for elderly or higher-risk patients, or for those who simply don't want to undergo an open surgery like a carotid endarterectomy, Osborne says.

"This will replace some transfemoral stents, but it'll also replace some carotid endarterectomies," Osborne notes. "Anyone with symptomatic carotid disease, or asymptomatic with more than 70 percent stenosis would qualify. This procedure is quickly being adopted nationally."

More Articles About: Health Tech Cardiac Surgery Frankel Cardiovascular Center Cardiovascular: Treatment & Surgery
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories heart organ yellow blue
Health Lab
Around 10% of deaths from coronary stenting, balloon angioplasty are preventable
Around 10% of all deaths following percutaneous coronary intervention are potentially preventable, a study led by Michigan Medicine finds.
Health Lab
Positive outlook propels woman through heart failure and on to a new heart
After seven years of waiting, a Michigan woman celebrates a lifesaving heart transplant and recovery close to home
Microscopic image of bone marrow with pink and white hues
Health Lab
Novel risk score for cardiovascular complications after bone marrow transplant
More bone marrow transplants, also known as hematopoietic stem cell transplantation, are being offered to older patients, a population at greater risk of cardiovascular disease.
Blurred image of health care professionals in blue scrubs pushing a gurney down a hallway
Health Lab
Primary care scarcity linked to more surgical emergencies, problems
Patients living in areas with the worst shortages of primary care providers are more likely to have emergency surgery, surgical complications and hospital readmissions.
Provider takes a pulse oximetry reading from a patient's finger
Health Lab
Inaccurate pulse oximeter readings could limit transplants, heart pumps for Black patients with heart failure
Racially biased readings of oxygen levels in the blood using pulse oximeters may further limit opportunities for Black patients with heart failure to receive potentially lifesaving treatments, such as heart pumps and transplants
News Release
Statewide cardiovascular consortium, hosted at Michigan Medicine, receives national award for patient safety, quality efforts
A collaborative partnership dedicated to improving statewide cardiovascular care and outcomes — hosted at Michigan Medicine — received national recognition for efforts in patient safety and quality. BMC2 received the award for its significant improvements in the documentation of radiation use, a decrease in high-dose radiation exposure and reduction in opioid prescribing rates for patients.