What is transcarotid artery revascularization?

Transcarotid artery revascularization (TCAR) is a procedure to open a narrowed carotid artery. This is done by placing a tiny expandable tube (stent) in the artery. There are two carotid arteries, one on each side of the neck. They supply blood to the brain. Fatty buildup (plaque) can narrow these arteries and limit blood flow to your brain. The plaque also raises your risk of stroke. TCAR may improve blood flow to your brain and lower your risk of stroke.

You will get medicine to block pain and make you relax or sleep. Then the doctor will make a small cut (incision) above your collarbone. The doctor will insert a thin tube (catheter) into the carotid artery. Blood flows through the catheter to a filter. This catches any bits of plaque that might break off and keeps them from moving to the brain. The filtered blood is returned to the body through a catheter inserted into a blood vessel in the groin.

Next, the doctor will move a balloon and a stent into the narrow section of the carotid artery. The balloon is inflated inside the stent. This opens the stent and pushes it into place against the artery wall. The balloon is then deflated.

The doctor will remove the balloon. The stent will stay in your artery. Over time, the cells lining the artery will grow through and around the stent to help hold it in place.

The filter system is turned off, and blood flow is returned to normal. Then the doctor will remove the catheter and close the incision.

You may stay at least 1 night in the hospital.

Activity

• If the doctor gave you a sedative:
  • For 24 hours, don't do anything that requires attention to detail, such as going to work, making important decisions, or signing any legal documents. It takes time for the medicine's effects to completely wear off.
  • For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
• Do not do strenuous exercise and do not lift, pull, or push anything heavy until your doctor says it's okay. This may be for several days. Try not to walk up stairs for the first couple of days. You can walk around the house and do light activity, such as cooking.
• If your doctor recommends it, be active. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
• Ask your doctor when you can drive again.
• Your doctor will tell you when you can have sex again.
• Carry your stent identification card with you at all times.

Diet

• You may notice that your bowel movements are not regular right after your procedure. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• Keep eating a heart-healthy diet that has lots of fruits, vegetables, and whole grains. If you need help with your diet, talk to your doctor. You also may want to talk to a dietitian. This expert can help you learn about healthy foods and plan meals.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Your doctor may prescribe a blood thinner such as aspirin. It is important that you take these medicines exactly as directed to help reduce your risk of a stroke. Be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Care of the groin catheter site

• For 1 day or for as long as your doctor recommends, keep a bandage over the spot where the doctor put the catheter in your groin.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
• You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
• Do not soak the catheter site until it is healed. Don't take a bath for 1 week, or until your doctor tells you it is okay.
• Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
• If you are bleeding, lie down and press on the area for 15 minutes to try to make it stop. If the bleeding does not stop, call your doctor or seek immediate medical care.

Incision care

• If you have strips of tape over your incision, leave the tape on for a week or until it falls off.
• You may shower and take baths as usual. But do not soak the incision for the first 2 weeks, or until your doctor tells you it is okay. Pat the incision dry.
• Wash the area daily with water and pat it dry. Don't use hydrogen peroxide or alcohol. They can slow healing. You may cover the area with a gauze bandage if it oozes fluid or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Transcarotid artery revascularization (TCAR) is a procedure to open a narrowed carotid artery. This is done by placing a tiny expandable tube (stent) into the artery. The doctor made a small cut (incision) in your neck to place the stent. A very small incision may have been made in your groin area.

You may have soreness, a bruise, and mild swelling where the doctor made the incision in your neck. You may also have swelling, bruising, or a small lump around the site where the catheter went into your groin. You can do light activities around the house. But don't do anything strenuous until your doctor says it is okay. This lets the incision sites heal.

You will take medicines to help prevent a stroke. You will still need to have a heart-healthy lifestyle. This lifestyle includes eating healthy foods, being active, staying at a healthy weight, and not smoking. This will give you the best chance for a longer, healthier life.

You will have regular tests to check the blood flow in your carotid arteries.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of procedure, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that makes you relax or sleep. The area being worked on will be numb.
• The procedure may take about 1 to 2 hours.
• After the procedure, pressure may be applied to the area where the catheter was put in your groin. This will help prevent bleeding. A small device may also be used to close the blood vessel. The area may be covered with a bandage or a compression device.
• You will need to lie still and keep your leg straight for up to a few hours. The nurse may put a weighted bag on your leg to keep it still.
• Your neck may be sore, and there may be a stitch where the doctor made the cut to insert the catheter.
• Nurses will check your heart rate and blood pressure. The nurse will also check the catheter site for bleeding.
• You may have a bruise or a small lump where the catheter was put in your groin. This is normal and will go away.