Patients with carotid artery disease have an increased risk of stroke. To help protect them from strokes, Stony Brook offers a safe, ground-breaking procedure called transcarotid artery revascularization (TCAR). This minimally invasive procedure treats carotid artery disease and is clinically proven to protect against stroke both during and after the procedure. Stony Brook was the first on Long Island to offer this revolutionary procedure.
Angela Kokkosis, MD, Director, Carotid Interventions, Stony Brook Vascular Center, with patient.
Carotid artery disease and stroke risk
Carotid artery disease is a blockage or narrowing in the arteries that carry oxygen-rich blood to the brain. The blockage, caused by cholesterol-filled plaque, reduces the amount of blood that flows to the brain. Because the blood isn’t flowing normally, blood clots can form or small pieces of plaque can break off and travel to the brain, causing a stroke. Every year, 15 million people worldwide suffer a stroke and carotid artery disease is estimated to be the source of the stroke in up to one third of patients.
Current treatment options for carotid artery disease
If the blockage or narrowing in the artery isn’t severe, lifestyle changes and regular monitoring may be the only action required. If the disease is more advanced, Stony Brook offers three different treatments depending on the individual patient and degree of severity:
- The traditional open surgery, called a carotid endarterectomy or CEA
- A minimally invasive procedure called transfemoral carotid artery stenting
- The state-of-the-art TCAR procedure that reduces the risk of stroke both during and after the procedure
The TCAR procedure
Transcarotid artery revascularization is a minimally invasive treatment performed by going into the carotid arteries to restore the flow of blood to the brain (revascularization). The procedure is a major advance in treating carotid artery disease. Here’s how it’s done:
- The procedure is performed with the patient under light sedation, in Stony Brook Hospital’s hybrid operating room. It takes about 90 minutes.
- The surgeon makes a tiny incision at the neckline just above the clavicle. The scar is so small that most people never notice it.
- A tube, called a catheter, is placed directly into the carotid artery.
- The catheter is connected to a revolutionary system called a neuro-protection system (NPS). The NPS temporarily reverses the blood flow away from the brain. So, if any plaque breaks loose or blood clots form during the procedure, it won’t go into the brain. This means that there is almost one hundred percent protection from stroke while the rest of the procedure is done.
- A stent — a metal mesh tube — is implanted into the carotid artery. The stent expands and opens the artery for improved blood flow. It also stabilizes the plaque to help prevent future strokes.
- The patient’s blood flow that was reversed is filtered to ensure there are no particles in the blood. The filtered blood is then returned through a second catheter in the upper thigh, and the flow reversal is turned off so the blood flows in the normal direction.
- After an overnight stay in the hospital to monitor blood pressure, the patient can go home and resume normal activities.
The stent that was placed in the artery stays in the body permanently, to keep the artery open and the blood flowing normally. It has been shown that over ten years, the degree to which the artery stays open after the TCAR procedure is equivalent to the results of the CEA surgery. And because TCAR is less invasive than traditional surgery, there’s a lower chance of complications.
“I can’t emphasize how important this is in the field of vascular surgery,” said vascular surgeon Angela Kokkosis, MD, Director, Carotid Interventions, Stony Brook Vascular Center. “It’s a treatment revolution for people who are at risk for strokes because of carotid artery disease.”
Who is eligible for TCAR?
To determine eligibility for TCAR, there are very strict criteria based on Centers for Medicare and Medicaid Services (CMS) guidelines as well as guidelines from the company that developed TCAR.
Generally, patients who have never had a stroke and have blockage greater than 80 percent but less than 100 percent are good candidates for TCAR. In addition, current guidelines are that TCAR may be right for patients with carotid artery disease who are considered high risk for traditional open surgery. Factors that make a person high risk — meaning the open surgery is not a good choice for them — include older age, anatomic issues or previous cancers or surgeries that may make the carotid blockage surgically inaccessible, and other medical conditions such as severe heart or lung disease.
TCAR is appropriate for patients of any age, though people who need carotid intervention are generally older. The average age of patients treated with TCAR recently at Stony Brook has been 75. The procedure is covered by Medicare.
An important milestone in treating vascular disease
After a stroke, many patients lose their quality of life. By reducing the incidence of strokes and the debilitation they can cause, TCAR can preserve quality of life for people with carotid artery disease. Due to the excellent outcomes patients are experiencing from TCAR, it is expected that the guidelines for who can get the procedure will be expanded to include a broader range of people with carotid artery disease.
Long Island’s leader in TCAR
Stony Brook has performed more TCAR procedures than any institution on Long Island, and we are second in New York State in terms of number of patients treated with TCAR. At Stony Brook, TCAR is performed by vascular surgeons Apostolos Tassiopoulos, MD, Chief, Division of Vascular and Endovascular Surgery and Angela Kokkosis, MD, Director, Carotid Interventions.