Joseph Glorioso, right, underwent a newer, less invasive procedure called TCAR to treat severe carotid artery disease and reduce his risk of a future stroke. Seth Blattman, MD, a vascular surgeon, performs the procedure at Bridgeport Hospital.
Joseph Glorioso had no idea what TCAR was, but he was more than pleased that his vascular surgeon did. This newer procedure for treating transcarotid artery revascularization – or TCAR for short – is less invasive than traditional methods in minimizing the risk of future stroke in patients at high risk for severe carotid artery disease.
Glorioso, who had had multiple mini-strokes called TIAs (transient ischemic attacks), said he recognized the oncoming symptoms of stroke. “When I started slurring my words, my wife took me to Bridgeport Hospital right away.”
A TIA, which can be the prelude to a full-blown stroke, may present with a sudden and temporary onset of visual, speech, language, balance, strength or sensation disturbances.
A stroke is a medical emergency and a leading cause of death and disability in the United States. After having a stroke, the chances of having another one can increase.
Carotid artery disease
For Glorioso, severe carotid artery disease was the culprit. Carotid arteries are blood vessels located on each side of the neck, supplying blood and oxygen to the brain. When a waxy substance called plaque builds up in the arteries over time, it can block the flow of blood to the brain resulting in a stroke.
“The left side was the worst,” Glorioso said. “The carotid artery on the left side of my neck was 90 percent blocked, and the carotid artery on my right side was 80 percent blocked.”
“Prior to TCAR, our main way to revascularize carotid arteries was through stenting versus the standard of care, which is carotid endarterectomy (CEA),” said Seth Blattman, MD, who performs the TCAR procedure at Bridgeport Hospital. “Carotid endarterectomy has been around for about 40 years and is tried and true.
“A carotid endarterectomy is strictly an open procedure,” he explained. “We open up your artery, the plaque is physically cleaned out, and a patch is usually used to close the artery.”
CEA removes the plaque from inside the carotid artery to the brain, but the large incision leaves a scar the length of the neck and may carry risks of surgical complications.
These can include bleeding, infection, heart attack, and cranial nerve injuries that can cause issues with swallowing, speaking and sensation in the face, explained Raul Guzman, MD, who is vascular surgeon-in-chief, Heart and Vascular Center (HVC) at Yale New Haven Health, and the Donald Gutherie Professor of Vascular Surgery at Yale School of Medicine.
TCAR is one of the many vascular surgery procedures offered through the HVC at Bridgeport Hospital and includes cardiologists from Yale Medicine and Northeast Medical Group as well as Yale Medicine cardiac and vascular surgeons.
What’s unique about TCAR?
“One of the unique aspects about TCAR – and why it makes it safer when we work on the blocked carotid artery – is we reverse the blood flow in the artery that goes to the brain,”Dr. Blattman explained. “If a small piece of plaque breaks off, instead of it going to the brain, it goes away from the brain, down through a filter.”
A flexible metal tube called a stent is then inserted in the carotid artery to stabilize the plaque, minimizing the risk of a future stroke.
Dr. Blattman said he has been using the TCAR method for the past several years with increasing frequency in patients who are considered at high risk for traditional surgery due to age and other medical conditions.
“The recovery rate when compared to carotid endarterectomy is a bit faster, as you don’t have a big incision in your neck; with TCAR, it’s a tiny incision just above your clavicle,” Dr. Blattman explained. “There is also a little less perioperative numbness around the incision site, and a quicker return to full function.
“Results show that TCAR is very safe, very effective and very time-tested. The data I have show that TCAR is a little safer than CEA and the recovery is certainly better,” Dr. Blattman said.
Glorioso said he’s pleased with the results. “I had never heard of TCAR before I met Dr. Blattman,” he said, “but it has worked perfectly for me.”
Learn more about stroke and more about vascular and endovascular procedures available at Bridgeport Hospital.
