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New Procedure for Carotid Artery Disease Reduces the Risk of Stroke

The less invasive procedure is a game-changing technology for stroke prevention and helps patients recover faster.


David Yearian was told he had the build-up of fatty deposits in his carotid artery which could lead to stroke. “I guess I never had a heart attack or anything, so I didn’t think it was that serious,” said Yearian, and 80-year-old Des Moines resident.

Carotid artery disease — also known as carotid stenosis — occurs when plaque builds up in one or two of the main arteries that come directly from the heart and provide blood to the brain. Left untreated, the plaque can slow blood flow or dislodge and travel through the artery to the brain, causing a potentially disabling stroke. Carotid artery disease is estimated to be the source of stroke in up to a third of cases, and there are 400,000 new diagnoses made every year in the U.S. alone.

New Option for Carotid Artery Surgery Helps Prevent Stroke

Dr. Douglas Massop“Some individuals can manage carotid artery disease with medications and lifestyle changes,” said Dr. Douglas Massop, MD, vascular surgeon at The Iowa Clinic in West Des Moines. “However, more severe cases may require surgery to repair the blockage in the artery. Traditional treatment options such as carotid endarterectomy (CEA) or carotid artery stenting (CAS) have been shown to effectively treat the blockage. However, both options have limitations and actually carry a risk of stroke during the procedures themselves.”

The Iowa Clinic is among the first in the Midwest to offer a new technology called TransCarotid Artery Revascularization (TCAR) to treat patients with carotid artery disease in a safe, minimally-invasive method. Like CEA, the TCAR procedure involves direct access to the carotid artery, but through a much smaller incision just above the clavicle instead of a longer incision along the entire neck. This creates just enough room to place a stent directly into the carotid artery to stabilize the blockage and help prevent future strokes.

“While CEA is recognized as a safe, effective surgery, it’s still a fairly major surgery that typically takes a couple of hours and usually requires general anesthesia,” said Dr. Massop. “TCAR is an important new, less invasive option in the fight against stroke and is particularly suited for the large portion of patients who are at higher risk of complications from carotid surgery due to age, other medical conditions or anatomic issues.”

How the TCAR Procedure Works

To protect patients from stroke during the TCAR procedure, a small tube inserted into the carotid artery is connected to a system that temporarily directs blood flow away from the brain — ensuring any dangerous debris that dislodges from the artery won’t reach the brain during the procedure. Any material is captured in a filter outside the body, and surgeons filter the blood before returning it to a vein in the groin. The stent is placed in the artery while the brain is protected during this temporary flow reversal.

The entire procedure is performed in approximately half the time of CEA — limiting the stress on the heart and reducing the risk of the patient having a stroke or heart attack. And since it’s less invasive, patients who undergo the TCAR procedure recover quickly and almost always go home the next day with less pain and a much smaller scar.

For David Yearian, the TCAR procedure worked wonders. "Once the bandage came off, I was ready to go.”

He was able to get back to his normal activities immediately. And, more importantly, his risk of stroke is greatly reduced, so he can stick to his normal activities for years to come.

Watch David’s story by Megan Reuther at WHO-TV Channel 13.

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