Advanced Vascular Surgery is pleased to announce the newest treatment procedure

TCAR ( Transcarotid Artery Revascularization )

Transcarotid Artery Revascularization (TCAR) combines surgical principles of neuroprotection with minimally invasive endovascular techniques to treat blockages in the carotid artery at risk of causing a stroke.

Carotid Artery Disease, Stroke, Transient Ischemic Attacks (TIAs)

Stroke is a leading cause of death and disability in the United States, it is estimated that 80 percent of strokes are preventable. A stroke occurs when a portion of the brain dies because it does not get enough blood. This usually occurs from narrowing of the carotid arteries, small pieces of plaque or clot that travel into the small arteries in the brain, and block the blood flow. If you have significant narrowing in your carotid artery from PAD, you may need the narrowing repaired for prevention of stroke.

What is carotid artery disease?

Carotid artery disease occurs when the major arteries in the neck become narrowed or blocked. These arteries, called the carotid arteries, supply the brain with blood. The carotid arteries extend from your aorta in yourthe chest to the brain.
The arteries are normally smooth and unobstructed on the inside, but with age, plaque can build up in the walls of the arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, the arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries.


Carotid artery disease may not cause symptoms in its early stages.
Unfortunately, the first sign of carotid artery disease could be a stroke. However, you may experience warning symptoms of a stroke called transient ischemic attacks, or TIAs. Symptoms of a TIA usually last for a few minutes to 1 hour and include:

  • Feeling weakness, numbness, or a tingling sensation on one side of your body, for example, in an arm or a leg
  • Being unable to control the movement of an arm or a leg
  • Losing vision in one eye (many people describe this sensation as a window shade coming down)
  • Being unable to speak clearly


  • Complete History and Physical Examination.
  • Carotid duplex ultrasound detects most cases of carotid artery disease and it is done in the office.
  • CT scan and CT Angiography (CTA): CT and CTA scans take pictures in the form of slices of the brain and the arteries in your neck.
  • Magnetic resonance angiography (MRA): MRA uses radio waves and magnetic fields to create detailed images. This test may help evaluate carotid artery disease.


Medical Management

This consists of smoking cessation, blood pressure and cholesterol control. Also anti-platelet agent like Aspirin may be prescribed.

Surgery (Carotid Endarterectomy)

The procedure is called carotid Endarterectomy. An incision is made in the neck. Plaque contained in the inner lining of the carotid artery is removed and the artery is closed with a patch. You may be able to leave the hospital as early as the day after the procedure.

Angioplasty and stenting

A minimally invasive procedure to treat carotid artery disease is angioplasty and stenting. Angioplasty and stenting is usually performed using a local anesthetic. To perform this procedure, a long, thin tube called a catheter is inserted through a small puncture site over a groin artery. The catheter is passed and is guided through the blood vessels to the carotid artery. A picture is then taken of the blockage, and a stent is placed in the blocked artery as needed.

Risks of Operation

Risks of Carotid Endarterectomy include bleeding, infection, small risk of stroke, risk of nerve damage, myocardial infarction and very small risk of death.

Risks of Carotid artery stenting include bleeding, stroke, renal failure, myocardial infarction and very small risk of death.