Emory First Site in Georgia to Offer Less Invasive TCAR Procedure for Carotid Stenosis
MAY 2016
Vascular surgeons of the Emory Department of Surgery are the first in Georgia, and among the first in the United States, to offer transcarotid artery revascularization (TCAR) to treat carotid stenosis — the buildup of plaque inside the carotid arteries that can lead to a potentially disabling stroke.
TCAR is a less invasive alternative to carotid endarterectomy (CEA), the open procedure which has been most commonly used to treat severe carotid stenosis. Any attempted repair of the carotid artery can itself cause a stroke, and while CEA is effective in preventing stroke during and after the procedure, it has associated risks that TCAR was designed to help lessen.
"CEA is initiated with an approximate 3-to-4 inch incision at the front of the neck, whereas TCAR gains direct access to the common carotid artery through a much smaller incision above the collarbone, allowing just enough room to place a sheath into the artery and deliver a stent," says Joseph Zarge, MD, assistant professor of surgery, who led the surgical team that performed Emory's first TCAR procedure at Emory Saint Joseph's Hospital. "Using local anesthesia, the stent is implanted in the carotid artery to open and stabilize the narrowing and help protect patients from future stroke risk."
Throughout the TCAR procedure, blood flow is temporarily reversed in the carotid artery to divert dangerous debris away from the brain, preventing a procedural stroke.
"Being able to offer our high-risk patients a safe, less invasive treatment for carotid stenosis is a very important step forward," says William Jordan, Jr., MD, chief of the Division of Vascular Surgery and Endovascular Therapy at Emory. "TCAR not only minimizes the rate and severity of nerve injury with a smaller incision, it allows patients to return to full and productive lives more quickly and minimizes scarring at the incision site on the neck."
The recently published multi-center ROADSTER Clinical Study evaluated the TCAR procedure in patients at high risk for complications from surgery. It demonstrated a low 1.4 percent 30-day stroke rate similar to results seen with CEA, but with a lower incidence of heart attack, nerve injury, and shorter hospital stay. The resulting data was used to support FDA clearance of the ENROUTE Transcarotid Neuroprotection and Stent System interventional tools used during the TCAR procedure.
Emory University is participating in the follow-up ROADSTER 2 trial, which is evaluating the TCAR procedure at up to 100 sites across the nation and involves a minimum of 600 patients.
"We are helping further evaluate this important innovation and are hopeful our participation in the ROADSTER 2 study will build upon the existing clinical evidence to help positively impact stroke prevention efforts in the U.S. and around the world," says Dr. Zarge, the Emory site's principal investigator.
