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Transcarotid artery revascularization, or TCAR, is revolutionizing stroke prevention. Compared to traditional surgery, TCAR has a smaller incision, reduced risk of stroke during the procedure, quicker recovery time, and fewer complications for high-risk patients, making it a safer, less invasive option for treating carotid artery disease.
A diagnosis of carotid artery disease (CAD)--a buildup of plaque in the coronary arteries that greatly increases the risk of heart attack or stroke–can feel overwhelming. The newly impending fear of suffering a stroke while trying to make the best decision about your treatment can leave you and your loved ones frantically searching for answers. Fortunately, advancements in medical technology over the past decade have made treating carotid artery disease safer and less invasive than ever before.
One of the most promising new treatments for treating CAD and reducing the risk of stroke is the transcarotid artery revascularization (TCAR) procedure, a method pioneered in Oklahoma by vascular surgeon Dr. Jim Melton at CardioVascular Health Clinic and most recently performed by Dr. Melton at an outpatient facility for the first in the U.S. This accomplishment means that patients undergoing the TCAR procedure can enjoy a faster recovery than in a hospital setting and with fewer risks, a huge relief for anyone facing surgery. It also means the procedure can be performed much more efficiently.
“[Performing the TCAR procedure in an outpatient facility] is a pretty big deal,” said Dr. Melton. “The cost is approximately 38% to 40% less in this setting than in the hospital, the infection rates are less because it’s a smaller space, and patients have one-on-one nursing the entire time they’re here.”
TCAR is truly changing how doctors prevent strokes, and it is just one of the innovative, minimally-invasive treatments offered at CardioVascular Health Clinic. The multidisciplinary team of national-caliber physicians, interventional radiologist, and cardiovascular experts leads the country in ground-breaking new options to help patients treat and manage cardiovascular conditions, and by combining decades of experience with a comprehensive, whole-person approach to care, we’re delivering better outcomes to more patients throughout Oklahoma and beyond.
TCAR is a leading-edge procedure that opens up blockages in the carotid artery and reduces the risk of stroke.
Carotid artery disease is a condition where your carotid arteries — the ones along the side of your neck that bring blood to your brain — become partially or almost completely blocked with plaque. If not treated, these blockages greatly increase your risk of a stroke.
Traditionally, treatment for carotid artery disease has involved cutting open the blocked artery via a large neck incision and removing the built-up plaque, but TCAR takes a unique approach.
Instead of making a large cut on the side of your neck, a smaller one is made near your collarbone. The small incision makes it an especially safe option for patients at high risk of complications from open surgery. The procedure also incorporates a flow reversal system that prevents plaque particles from reaching the brain during stent placement, further reducing the risk of stroke.
For patients with carotid artery disease, there are a few main treatment options. The two most common treatments are carotid endarterectomy (CEA) and carotid stenting, and while each method has advantages, TCAR stands out for several reasons.
One of the greatest advantages of TCAR is that it’s far less invasive than traditional surgery. Instead of a long, large incision in the neck, TCAR requires only a small cut near your collarbone. As a result, TCAR leaves a smaller and much less noticeable scar lower down that may be more easily covered with clothing.
With a small incision, there’s also less of a physical toll on your body. There’s not as much scarring, a lower risk of infection, and you’ll heal faster. This minimally invasive approach also means you might experience less pain during recovery and be able to return to your normal activities sooner.
The most concerning risk for anyone undergoing carotid surgery is the chance of a stroke happening during the operation itself. Traditional carotid endarterectomy (CEA) involves removing plaque directly from the artery, but there’s a chance that pieces can break free and travel to the brain, potentially causing a stroke during the procedure.
TCAR was developed to reduce this risk. During a TCAR procedure, a tube is connected to your artery, and blood is directed away from your brain in efforts to prevent plaque from reaching the brain during the stenting and ballooning process to the carotid artery. This reduces the risk of stroke and provides extra peace of mind for patients and their families.
Recovering from TCAR is generally quicker as compared to traditional surgery. With TCAR, most patients are able to go home the next day. In some cases, they may even go home on the same day as the procedure.
In comparison, carotid endarterectomy surgery often requires a longer hospital stay. Which means more time off work and regular activities. The faster recovery time with TCAR allows patients to get back to their daily lives sooner with minimal disruption from the procedure.
Some patients may not be ideal candidates for traditional surgery due to their age, medical history, or other risk factors. TCAR is often a safer alternative since the minimally invasive nature of the procedure reduces the strain on the heart and lungs. For those who may not tolerate surgery well, TCAR provides a different option.
Patients with high surgical risk include those with heart disease, kidney issues, or other complex health conditions. Their doctors may recommend TCAR as a much safer and more manageable option, rather than risking traditional surgery.
Many traditional surgeries require several days in the hospital. TCAR has a much faster recovery, and for many, it allows people to go home on the same day. This is a huge advantage for patients who prefer the comfort of recovering at home or who are looking to avoid lengthy hospital stays. An outpatient procedure is also significantly less expensive than one that requires a hospital stay and easier to schedule, navigate, and follow up with.
In September 2024, Dr. Melton and CardioVascular Health Clinic became the first outpatient facility in the nation to perform TCAR outside of a hospital setting. This allows for the same high-quality care without the need for being admitted to a hospital, making the process smoother, safer, more convenient, and less costly for patients.
TCAR is typically recommended for patients with moderate to severe carotid artery disease who are at high risk for traditional surgery. These might include older adults, patients with significant medical conditions, or individuals who have already undergone surgery or radiation treatment to the neck.
However, it’s important that you consult with your doctor to determine the best treatment for your specific symptoms and history. While TCAR offers many advantages, each person’s situation is different, and a healthcare provider will guide you toward the right treatment.
The diagnosis of CAD and subsequent fear of a stroke are understandably frightening, but TCAR is changing the way carotid artery disease is treated. TCAR is safe, effective, and minimally invasive — a promising alternative to traditional surgery. With a quicker recovery and a reduced risk of complications, TCAR offers an attractive–and potentially more affordable–option for patients or their loved ones.
If you’ve been diagnosed with carotid artery disease and are considering different treatment choices, consult with the vascular specialists at CardioVascular Health Clinic. Our team of experts have been at the forefront of cardiovascular care for decades, pioneering treatments that redefine care. With our commitment to innovation, minimally invasive techniques, and a multidisciplinary approach, we can offer hope for people who have not had answers or solutions before.Contact CardioVascular Health Clinic today to learn more about TCAR or schedule an appointment. Your health–and your life–depend on it.
