Neck blood vessel blockage and stroke risk: Learn about TCAR treatment (Transcarotid Artery Revascularization)

You've probably heard a doctor say, "A major blood vessel in your neck is blocked, and this increases your risk of having a stroke." It's normal for anyone to feel a little scared when they hear something like this. But don't worry, because medical science has advanced and there are now very effective ways to treat such conditions. Today we're talking about TCAR, a modern and safe treatment method that is used to reduce the risk of stroke.

What is TCAR? Let's understand it simply.

TCAR (Transcarotid Artery Revascularization) is a special treatment that repairs blockages in the main blood vessel in your neck called the Carotid Artery . Imagine that something similar happens here, like a clogged drain in your home. Inside these blood vessels, things like fat and cholesterol accumulate and form a layer. We call this 'Plaque' .

This plaque layer gradually narrows the blood vessel. The most dangerous thing is that if a piece of this plaque breaks off and blocks a blood vessel in the brain, or if this blockage completely stops blood flow, a stroke can occur.

So to prevent this risk, doctors treat these blockages to remove them. There are three main methods for this:

1. Carotid Endarterectomy (CEA): This is a traditional open surgery. The doctor makes an incision in the neck, opens the blood vessel, and manually scrapes away the plaque.

2. Carotid Angioplasty and Stenting (CAS): This involves passing a thin tube through a blood vessel, usually in the groin or arm, to the blocked area in the neck, and using something like a balloon to widen the blockage. Then, a mesh-like device, called a stent, is inserted to keep the vessel from narrowing again.

3. TCAR treatment: This is a bit similar to the CAS method, but a more modern and safer method. Here, the stent is inserted through a small incision in the neck, rather than through the groin. We will talk about the special features of this later.

Who is TCAR treatment particularly suitable for?

TCAR was first introduced for patients who were at high risk of complications from traditional open surgery (CEA). Factors that may increase this risk include:

• Getting older.
• Presence of heart disease or lung disease.
• Having scar tissue on the neck from previous neck surgery or radiation therapy.
• If the blockage is in a difficult place to operate on, such as under the jawbone.

But now this method is also being used successfully for patients with normal risk levels.

How do you prepare before surgery?

If you decide to have TCAR treatment, your doctor will first order several tests.

• Blood tests
• Ultrasound scan of the carotid arteries in the neck
• A special CT scan (CT Angiogram) that examines the blood vessels in the neck and brain

In addition, you may be started on several medications to prepare you for surgery. These may include cholesterol-lowering medications like statins and blood-thinning medications like aspirin.

The most important thing is that the doctor will advise you not to eat or drink anything after midnight the night before the surgery. It is very important to follow those instructions exactly.

How is TCAR surgery performed?

This is a truly amazing, technologically advanced procedure. Here's what happens in the operating room in simple terms:

1. Anesthesia: This is done by putting you completely to sleep (General Anesthesia) or by numbing only the area around your neck (Local Anesthesia).

2. Blood filtration system: Next, a thin tube is inserted into a vein in your groin (femoral vein). This is then used to return the cleaned blood to your body.

3. Neck incision: A small incision, about an inch long, is made in the neck, just above the collarbone, on the side of the blockage.

4. Reversing the blood flow: Now the most important thing happens. Another tube is inserted into the carotid artery through that small incision, and that tube is connected to the tube in the groin through a special filter. Then, the blood flow in the carotid artery is temporarily diverted from the direction of the brain, to the other way!

5. Safety: This means that even if any plaque fragments break off during the procedure, they won't travel to the brain. Instead, the blood is filtered, trapping all the debris, and only clean blood is returned to the body through the vein in the groin. This is the main safety measure that prevents the risk of stroke.

6. Stent placement: Now the doctor uses a thin wire to go through the blockage, dilates it with a balloon, and inserts a metal mesh-like stent . This ensures that the blood vessel remains open.

7. Finishing: Then all the tubes are removed, and the small incisions in the artery and neck are sewn closed. The entire procedure takes about an hour and a half.

Recovery and long-term care

After TCAR surgery, you will stay in the hospital for about a day. During this time, the medical staff will be constantly monitoring your condition. Since this is a minimally invasive surgery, it does not take long for the wounds to heal.

After you go home, you should avoid heavy lifting for about a week. Talk to your doctor about when you can return to work. It's also important to check your neck wound regularly to make sure it's healing well and for signs of infection.

When to call the doctor

If you have any of these signs that suggest the wound is infected, call your doctor immediately:

• Fever
• Feeling cold and shivering
• Redness around the wound
• Fluid-like discharge from the wound

After a stent is placed, you have a big responsibility to keep your blood vessels from becoming blocked again. To do this, you must do the following:

• Stop smoking completely.
• Exercise regularly.
• Eat a healthy diet low in saturated fats.
• Take the medication your doctor prescribes to control cholesterol and blood clotting on time.

TCAR surgery, carotid artery, stroke prevention, neck artery blockage, stent placement, carotid surgery Sinhala, stroke risk