Tenet Health Central Coast Now Offers an Innovative and Safe Procedure to Treat Carotid Artery Disease and Help Prevent Future StrokesJun 5, 2022
Physicians know, and have been telling patients for years, that blockage of the Carotid artery (Carotid stenosis) is no small matter – it is estimated that up to a third of stroke cases are caused by the buildup of plaque in one or both of the arteries in the neck that supply blood from your heart to your brain.
While treatments to lower cholesterol and thin the blood to improve blood flow to the brain are essential first steps, if the degree of narrowing in the artery is severe, surgery may be needed to open the blood vessel and clean the artery. However, as with any surgery, there is a risk of stroke or heart attack from the most common current procedures: Carotid Endarterectomy (CEA) and Carotid Transfemoral Stenting (TFS).
Now, Tenet Health Central Coast will be the first in San Luis Obispo County to offer an innovative surgical alternative, Trans-Carotid Artery Revascularization (TCAR), which reduces greatly the risk of stroke and heart attack from the surgery itself and keeps the brain safe during the procedure.
Until this advanced approach, the most common procedures have been surgery through the neck that directly goes to the artery to remove plaque, and TFS, which enters the artery through the groin area. As with any surgery, the risk of stroke or heart attack is serious, and especially due to the location of the Carotid Artery near the brain.
However, TCAR actually reverses blood flow, filtering blood in the process, which greatly reduces the risk of traditional Carotid Artery procedures.
Dr. Spencer Hansen, who has performed some 50 of these surgeries before providing the procedures at Tenet Health Central Coast, said that the goal is to decrease the risk of stroke while minimizing the perioperative risk of heart attack, even in high-risk patients.”
“The game-changer for this is the ability to treat people who are at high risk,” said Hansen. “There are criteria that patients have to meet for an intervention. We have an older population in this region and the TCAR procedure is the most up-to date technology for high risk interventions.”
With TCAR, the entire procedure is performed through a smaller incision in the neck and in less than half the time of a carotid endarterectomy (CEA) procedure – limiting the stress on the heart and significantly cutting the risk of the patient having a stroke or heart attack during the procedure. This minimally-invasive approach also means less scarring and, potentially, fast healing.
Over 20,000 procedures have been performed worldwide, and the clinical data has been excellent. In fact, a study published in 2019 in the Journal of Vascular Surgery found that TCAR carried significantly lower rates of in-hospital stroke (1.9% vs 3.3%) and stroke death (2.2% vs 3.8%), plus data demonstrating less hypotension, lower fluoroscopy (X-Ray imaging) times and contrast volume. It also showed a lower likelihood of a prolonged hospital stay, and increased discharge home in patients treated with TCAR rather than stenting.
That study is in line with published clinical trials in 2015, which showed the procedure offers several advantages: TCAR results in a low peri-procedural stroke rate of 1.4% in high surgical risk patients. This compares favorably to a 2.3% stroke rate of CEA and a 4.1% stroke rate of the FTS approach in standard-risk patients. TCAR’s low stroke rate is the lowest reported to date for any prospective, multi-center trial of carotid stenting.
“This type of procedure isn’t necessarily going to replace the other carotid surgeries, but it’s an important, safe way to bridge the gap between the risks of other procedures,” said Dr. Hansen. “I can tell you that the early adopters are now doing TCAR up to 80-90 percent of their cases, but we do this on a case-by-case basis. If people qualify, it’s a great option.”
Tenet Health Central Coast is already the first certified Thrombectomy Capable Center in San Luis Obispo County and has an exclusive relationship with the University of California, San Francisco and UCSF Health to provide access to a nationally-recognized network of neurological and spine care services here on the Central Coast. Now, Tenet Health Central Coast provides one of the safest and minimally invasive treatments to prevent stroke for those at the highest risk.