Are the blood vessels in your neck blocked? Let's learn about TCAR surgery (Transcarotid Artery Revascularization)

Has your doctor told you that a major blood vessel in your neck is blocked and that you are at high risk of having a stroke? It's normal for anyone to be a little scared when they hear something like that. "Will I have to have surgery? Is it a big deal?" Many questions probably come to mind. But don't worry, because medical science has advanced, there are now very safe, simple and effective treatments for such conditions. Today we are going to talk about one of the newest and most successful treatments, TCAR.

Simply put, what is TCAR?

The full name of TCAR is Transcarotid Artery Revascularization . Okay, this name sounds a bit complicated, doesn't it? Let's keep it simple.

There are two main blood vessels on either side of our neck that carry blood to the brain. We call these the carotid arteries . These are like the two main pipes that bring water to our house. Over time, things like fat and cholesterol from the foods we eat build up inside these blood vessels, like rust building up inside a water pipe. This is called 'plaque' in medical terms.

As this 'plaque' layer gradually grows larger, the space inside the blood vessel decreases, and the blood flow becomes blocked. The most dangerous thing is that if a small piece of this 'plaque' layer breaks off and travels to the brain with the blood, it can block a blood vessel in the brain and cause a stroke .

So, reopening this blocked blood vessel and restoring blood flow is what we call 'revascularization.' There are several main ways to do this.

1. Carotid Endarterectomy (CEA): This is a traditional open surgery. In this, a small incision is made in the neck, the blood vessel is opened, the layer of 'plaque' inside is removed, and the blood vessel is stitched back together.

2. Carotid Angioplasty and Stenting (CAS): A very thin tube is passed through a blood vessel in the groin or arm and guided to the blocked blood vessel in the neck. The blocked area is then widened with something like a balloon, and a 'stent' , a small mesh tube, is inserted to prevent it from closing again.

3. TCAR (Transcarotid Artery Revascularization): TCAR is a safer, more modern method that combines the best of both methods. It involves making a very small incision just above the collarbone in the neck and inserting a stent directly into the blocked blood vessel.

Who is this TCAR surgery best suited for?

The TCAR method was first introduced in 2015 for patients who were at high risk for traditional open surgery (CEA). That is:

• For older people.
• For those with heart or lung disease .
• For those who have scar tissue from previous neck surgery or radiation therapy.
• If the blood vessel is blocked in a place where surgery is difficult, such as under the jawbone.

But now this method is so successful that since 2022, TCAR treatment has been recommended even for patients in normal health, that is, those without special risk factors. So far, more than 20,000 TCAR surgeries have been performed in the United States alone.

How do you prepare before surgery?

If your doctor decides to perform TCAR surgery on you, he or she will need to perform several tests beforehand.

• Blood tests: Find out about your general health and blood clotting ability.
• Carotid artery ultrasound scan: See how much of the blood vessel is blocked.
• CT Angiogram: Get a clearer, three-dimensional image of the blood vessels in the neck and brain.

Also, the doctor will start you on several medications to prepare you for the surgery.

• Statin- type medications that lower cholesterol.
• Medicines like aspirin and clopidogrel that prevent blood clotting.

You will be advised not to eat or drink anything after midnight the night before the surgery.

How the surgery is done: step by step

This surgery will take about an hour and a half. Let's take a quick look at what happens in the operating room.

1. Anesthesia: To prevent you from feeling any pain, either the area around your neck will be numbed (local anesthesia) or you will be completely anesthetized (general anesthesia) .

2. Small incision: A very small incision is made on the neck, just above the collarbone, about 1-1.5 inches.

3. Flow Reversal: This is the most important and safest step in the TCAR procedure.

• A thin tube is inserted into a vein in the groin (femoral vein).
• Another tube is inserted into the blocked carotid artery through the neck incision.
• Now, these two tubes are connected to a machine with a special filter. After that, the blood flow to the brain is temporarily stopped, and the blood from the artery in the neck comes through that tube, is cleaned by the filter, and returns to the body through the tube in the groin.
• At this point, the blood your brain needs comes from the carotid artery on the other side of your neck and the vertebral arteries at the back of your brain.It is available without any hindrance.

4. Opening the blockage: A thin wire is used to go beyond the blockage and widen the area with a small balloon.

5. Stent placement: Next, a small metal mesh tube, called a stent , is inserted into the blockage. This keeps the blood vessel open and holds the plaque against the wall.

6. End: Then all the tubes are removed, and the small hole in the blood vessel and the incision in the neck are sewn up.

What happens after the surgery?

After TCAR surgery, you will need to stay in the hospital for about one night . Doctors and nurses will monitor your well-being regularly. Since this is a very simple surgery, recovery is also very quick.

What are the risks and complications?

As with any medical treatment, TCAR can carry some very small risks. However, the likelihood of these occurring is very low.

• Bleeding or swelling from the incision site.
• Infection of the incision.
• Minor damage to a nerve in the neck.
• Stroke.
• Heart attack.

Your doctor will explain these risks to you in more detail. Remember that special steps are taken to minimize these risks during the TCAR procedure.

Recovering and living with a stent

TCAR is a very quick procedure because there is no large incision.

• Avoid lifting weights for a week or two.
• Check the incision on your neck daily to make sure it is clean and there are no signs of infection.
• Ask your doctor when you can return to your job and other daily activities.

After the stent is placed, it is up to you to prevent the blood vessel from becoming blocked again. To do this, you must do these things.

• If you smoke, stop immediately.
• Exercise regularly.
• Adopt a healthy diet low in saturated fats.
• Take the blood-thinning medication and cholesterol-lowering medication prescribed by your doctor exactly on time.

When should I see the doctor?

If you see signs of infection at the incision site, call your doctor immediately.

• Fever
• If you feel cold
• If there is redness and swelling around the incision
• If something like liquid comes out of the cut

Your doctor will decide which treatment is best for you. Discuss any questions, concerns, or doubts you have with him. His goal is to provide you with the most appropriate and safest treatment.