Our Summary

The research paper discusses a new method for treating blocked arteries in the neck, which can lead to strokes. This method, called Transcarotid artery revascularization (TCAR), is unique because it doesn’t involve the aortic arch and uses a system that lowers the risk of embolic events (which are like blockages) during the procedure. The studies show that this method has a lower risk for stroke or death than other methods, like the transfemoral carotid stenting method, and a similar risk to traditional carotid endarterectomy, which involves surgery to remove the blockage. Additionally, TCAR has other benefits like lower risk of heart attack, nerve injuries in the head, and it takes less time than endarterectomy. As a result, TCAR is now being used more widely in the US for patients who have high-risk health conditions or challenging surgical anatomy.

FAQs

  1. What is transcarotid artery revascularization (TCAR)?
  2. How does TCAR compare to traditional carotid endarterectomy in terms of risk and benefits?
  3. Why is TCAR considered a good treatment option for patients with high-risk medical comorbidities and challenging surgical anatomy?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about carotid endarterectomy is to follow post-operative care instructions carefully, including taking prescribed medications, keeping the surgical site clean, and attending follow-up appointments. It is important to monitor for any signs of infection, such as redness, swelling, or drainage at the incision site, and to contact your doctor if you experience any unusual symptoms, such as weakness or numbness on one side of the body, difficulty speaking or understanding speech, or sudden vision changes. Following these guidelines can help ensure a successful recovery and reduce the risk of complications.

Suitable For

Patients who are typically recommended carotid endarterectomy include those with symptomatic carotid artery stenosis greater than 50%, asymptomatic patients with carotid artery stenosis greater than 60-80%, and those with high-risk medical comorbidities that may make them poor candidates for carotid stenting. Additionally, patients with challenging surgical anatomy, such as those with a tortuous aortic arch, may also be recommended for carotid endarterectomy. It is important for patients to undergo a thorough evaluation by a vascular surgeon to determine the most appropriate treatment option for their specific condition.

Timeline

Before carotid endarterectomy:

  1. Patient undergoes a thorough medical history and physical examination to determine the need for carotid endarterectomy.
  2. Diagnostic tests such as carotid ultrasound, magnetic resonance angiography (MRA), or computed tomography angiography (CTA) may be performed to assess the degree of carotid artery stenosis.
  3. Patient may need to undergo additional tests such as electrocardiogram (ECG), echocardiogram, or blood tests to assess overall cardiovascular health.
  4. Patient may be advised to make lifestyle changes such as quitting smoking, managing blood pressure, and controlling cholesterol levels to reduce the risk of complications during surgery.

After carotid endarterectomy:

  1. Patient is monitored closely in the hospital for any signs of complications such as bleeding, infection, or stroke.
  2. Patient may be prescribed medications to prevent blood clots and reduce the risk of stroke.
  3. Patient may need to undergo physical therapy to regain strength and mobility after surgery.
  4. Follow-up appointments with the surgeon are scheduled to monitor recovery and assess the effectiveness of the procedure.
  5. Patient is advised to continue lifestyle changes and adhere to a healthy diet and exercise regimen to maintain overall cardiovascular health and prevent future complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with carotid endarterectomy?
  2. How long will the recovery period be after the procedure?
  3. What are the expected outcomes of the carotid endarterectomy in terms of reducing the risk of stroke?
  4. Are there any alternative treatment options to carotid endarterectomy that should be considered?
  5. How many carotid endarterectomy procedures have you performed, and what is your success rate?
  6. What are the specific steps involved in the carotid endarterectomy procedure?
  7. How long will I need to stay in the hospital after the procedure?
  8. What is the long-term prognosis for patients who undergo carotid endarterectomy?
  9. What lifestyle changes or medications will I need to take after the procedure to prevent future blockages in the carotid artery?
  10. Are there any specific follow-up appointments or tests that will be necessary after the carotid endarterectomy?

Reference

Authors: Liang P, Schermerhorn ML. Journal: Adv Surg. 2022 Sep;56(1):111-127. doi: 10.1016/j.yasu.2022.02.004. Epub 2022 Jul 20. PMID: 36096563