Preventing Strokes for People with Carotid Artery Disease

KokkosisAngela Kokkosis, MD
Vascular Surgeon
Director, Carotid Interventions
Stony Brook Vascular Center

Patients with advanced carotid artery disease have an increased risk of having a stroke that may significantly decrease their quality of life. To help reduce the incidence of stroke, vascular surgeons at Stony Brook Vascular Center are using an advanced procedure called transcarotid artery revascularization — TCAR. This is a safe, minimally invasive procedure that can give patients a future without strokes. Angela Kokkosis, MD, a vascular surgeon, explains.

What is carotid artery disease?
This disease is a blockage or narrowing in the carotid arteries that carry oxygen to the brain. Caused by a buildup of plaque in the arteries, the disease reduces the amount of blood flowing to the brain. When blood isn’t flowing normally, blood clots and small pieces of plaque can break off and travel to the brain, causing a stroke. It’s estimated that carotid artery disease may be the cause of up to one-third of strokes.

What is TCAR and why is it such a breakthrough?
TCAR is a minimally invasive procedure that is a proven safe and effective way to open up the carotid arteries so blood flows normally to the brain. This is done by implanting a metal mesh tube called a stent into the carotid artery through a tiny incision just above the clavicle. The stent expands to allow blood to flow normally through the artery. The stent stays in place permanently to help stabilize the plaque and protect from future strokes.

What makes the procedure so revolutionary is a unique system that also protects the patient from stroke during the procedure. The system, called a neuro-protection system (NPS), temporarily reverses blood flow away from the brain during the procedure. So, if any plaque breaks loose or blood clots form during the procedure, it won’t go into the brain. Instead, it is trapped in a filter and eliminated from the blood, which is returned to the brain safely.

Who can get the TCAR procedure?
TCAR can be a good choice for people who are considered high risk for the open surgery that is traditionally used to treat carotid artery disease. Our vascular surgeons can evaluate the degree of artery blockage and other factors to determine if TCAR is a good option. Even patients with significant illnesses may be considered for TCAR.

How does TCAR improve quality of life?
After a stroke, some patients may experience significant challenges to living a normal life. By reducing the incidence of strokes, TCAR can preserve quality of life for people with carotid artery disease. Most importantly, the reduction in stroke risk lasts for many years.

Is TCAR safe?
Yes. The safety and effectiveness of TCAR has been well established. More than 2,500 successful procedures have been done worldwide. Because TCAR is minimally invasive, there is less chance of surgical complications, and patients recover and are able to resume normal activities quickly. The procedure is FDA approved and covered by Medicare.

What makes Stony Brook a good place to be treated?
Stony Brook was the first on Long Island — and is still the only institution in Suffolk County — to offer TCAR. We’ve performed more TCAR procedures than any institution on Long Island, and are second in New York State in terms of number of patients treated with TCAR. In addition to TCAR, we offer the full range of treatments, including the traditional open surgery, called a carotid endarterectomy or CEA, and a minimally invasive procedure called transfemoral carotid artery stenting.

TCAR is for patients who have carotid artery disease, with or without symptoms, and who are at risk for stroke. To make an appointment with our vascular specialists, call us at (631) 444-1279.

For more information about Stony Brook Medicine, call (631) 444-4000.