SUMMIT, NJ — Atlantic Health System’s Overlook Medical Center is the first hospital in New Jersey to offer an innovative new treatment for patients at risk for stroke due to blockages in the neck arteries, a condition known as carotid artery disease.
The minimally invasive procedure, called TransCarotid Artery Revascularization or TCAR, utilizes a new FDA-approved neuroprotection system that temporarily reverses blood flow in the artery during the procedure. Dangerous bits of plaque and blood clots that could dislodge and otherwise travel to the brain and cause a stroke are safely diverted away while a dedicated transcarotid stent is inserted to open and stabilize the blockage.
Prior to TCAR, the main treatment option for severe carotid artery disease was an open surgical procedure called carotid endarterectomy. The surgical technique allows for protection of the brain during the procedure, but the incision leaves a visible scar on the neck and carries risks of surgical complications including bleeding, infection, heart attack, and cranial nerve injuries that can cause issues with swallowing, speaking, and loss of sensation in the face.
“The carotid artery is a very sensitive area to work on due to its proximity to the brain,” said Scott Sundick, MD, vascular surgeon who is performing the procedure at Overlook. “By significantly reducing the risk of stroke, the TCAR procedure allows us to more easily work in the artery, which ultimately means the patient will have a better outcome, recover quickly and have less pain. It represents the modernization of carotid repair.”
A company based in California, Silk Road Medical, has worked for more than 10 years with the vascular surgery community to developing the TCAR procedure.
The standard carotid stenting procedure -- already being performed at Overlook -- involves navigating from a typical entry point in the patient’s femoral artery in the groin (transfemoral) all the way through the body up to and across the blockage in the neck. Along the way, friable vascular disease can get dislodged and travel to the brain and cause a stroke. Clinical trials of transfemoral carotid stenting showed a twofold risk of stroke relative to carotid endarterectomy.
“TCAR starts at the neck, not the groin, which bypasses a big source of stroke risk historically associated with transfemoral carotid stenting. After gaining transcarotid access, we then initiate temporary blood flow reversal as the first step of the TCAR procedure to make sure the brain is adequately protected before placing the stent. It’s a very logical yet ingenious technology,” Dr. Sundick explained.
The procedure also allows doctors to treat more patients, Sundick noted. Patients over 80 years of age, or who were otherwise not candidates for traditional surgery, may now be able to be treated for carotid artery disease through TCAR.
“TCAR is an important new option in the fight against stroke, and is particularly suited for the large portion of patients we see who are at higher risk of complications from carotid endarterectomy due to age, other medical conditions, or anatomic issues. Because of its low stroke risk, we think TCAR has the potential to become the standard of care for all patients,” Sundick said.
Every year, 15 million people worldwide suffer a stroke, also known as a “brain attack.” Nearly six million die and another five million are left permanently disabled. Stroke is the second leading cause of disability globally. 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 of carotid artery disease made every year in the United States alone.,
Results from clinical trials of TCAR were so compelling that the Society for Vascular Surgery (SVS), in collaboration with the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS), recently launched a novel program called the TCAR Surveillance Project. This program provides expanded insurance coverage of TCAR procedures for Medicare beneficiaries while allowing individual hospitals and the society to track quality benchmarks.