TCAR procedure reduces risk of stroke during endarterectomy
Less time, faster recovery, fewer complications
Paul Butler is no stranger to carotid artery disease or endarterectomy, the procedure that opens blockages in the neck caused by accumulated plaque in the artery. He’d undergone the surgery more than 12 years ago, and afterward regularly monitored his condition under a doctor’s care.
So when his doctor recently told him his artery needed to be revascularized, Paul was happy to learn he was a candidate for an innovative new procedure offered locally only through surgeons at Midwest Aortic & Vascular Institute.
Typical treatment is carotid endarterectomy where an incision is made in neck to directly remove plaque from the artery. Carotid stenting and transfemoral stenting can also be used when a patient’s risk is too high to undergo carotid endarterectomy. While complications are rare, the procedure – like any surgery – carries a small risk of stroke if a piece of plaque breaks off and travels to the brain.
The new procedure used by surgeons at MAVI – TransCarotid Artery Revascularization (TCAR) - is designed to access the carotid arteries through an incision in the neck instead of the groin and uses a blood flow reversal system to capture and divert pieces of the blockage dislodged during the procedure from potentially traveling to the brain, causing a stroke.
“When Dr. Kujath explained the new procedure, I felt a little more comfortable going into it, knowing there was reduced risk involved,” said Paul. “It was something I was always a little worried about, the risk of stroke. I have a lot of faith in Dr. Kujath, so it was okay.”
According to the National Heart Lung and Blood Institute, more than half of the strokes occurring in the United States each year are caused by carotid artery disease. A person with the disease may not experience any signs or symptoms until a stroke occurs. The carotid arteries are two large blood vessels on either side of the neck that supply oxygenated blood to the brain. Cholesterol or fatty substances can narrow one or both of the carotid arteries, causing carotid artery disease. If a piece of plaque breaks off, it can travel to arteries in the brain and cut off blood flow, resulting in a stroke.
The TCAR device captures debris by temporarily shunting blood flowing through the narrowed section of the artery away from the brain and into a filtering system outside the body to protect the brain from plaque fragments that may break loose during the procedure. Blood is then returned to the body though a vein in the leg. Because the carotid artery branches into many interconnected smaller arteries, the brain still receives oxygenated blood during the procedure.
Patients are treated in the hospital under general anesthesia and usually are discharged after a one-night stay. The procedure takes less time, recovery is faster and there’s less chance for complications.
In Paul’s case, he spent the night at North Kansas City Hospital, had a quick and uneventful recovery, and is back at work at his job at Worlds of Fun as a foreman in the electronics department.
“Not everyone is a candidate for TCAR,” said vascular surgeon Scott Kujath, M.D. “Each patient is evaluated on an individual basis.”
Anyone considered for traditional carotid endarterectomy is a potential candidate for TCAR, if they meet criteria. For patients whose anatomy did not permit access to the carotid arteries through the groin, TCAR is a possible life-saving treatment option.
“It’s an exciting new technology and another tool in our toolbox to treat carotid artery disease,” said Dr. Kujath.
Saving lives and limbs
Retired meat cutter William Accomondo enjoys the simple pleasure of standing on his own two feet these days, thanks to the advanced care provided by Midwest Aortic & Vascular Institute.
What started out as a simple sore on his foot put Accomondo on a path to possibly losing his right leg.
“It was a circulation problem. Two bypass surgeries (to reroute the blood supply around his blocked arteries) didn’t help, and I kept developing wounds that wouldn’t heal. My toes went all black and blue on me,” says Accomondo.
His blood flow compromised, Accamondo required amputation of four toes on his right foot.
Accomondo isn’t alone. Approximately 185,000 amputations occur in the United States each year. Critical Limb Ischemia (CLI) – Accomondo’s diagnosis – is a severe blockage of the arteries that reduces blood flow to the extremities and progresses to the point of pain, skin ulcers and sores. People with CLI have up to a 40 percent chance of amputation within the first 6 months that symptoms present.
Those most at risk have diabetes, high cholesterol, heart disease or a history of smoking.
Rounds of hyperbaric oxygen therapy helped, but not enough. Accomondo developed new sores on his big toe and heel that just wouldn’t heal properly. While waiting for his scheduled leg amputation surgery, Accomondo’s doctors at Midwest Aortic & Vascular Institute presented him with a hail Mary option. Fortunately, he was an ideal candidate for participation in a clinical trial offered in Kansas City only through Midwest Aortic & Vascular Institute.
The Harvest Technologies trial sought to determine if injections of concentrated bone marrow stem cells (non-embryonic) into damaged tissues would result in improved blood flow, reduce pain and save the limb. Bone marrow aspirate was collected and processed to remove the red blood cells. The resulting concentrate of cells was injected back into Accomondo’s leg tissue.
Though the study was double blinded – meaning that neither study participants nor researchers know who is getting a placebo and who is getting the treatment – Accomondo’s condition improved markedly.
Today, he can walk on his right leg without pain and no new wounds have developed. After facing amputation, he’s grateful his leg was saved. “I’m ecstatic about it,” says Accomondo.
Are you a candidate for a vascular clinical trial? Ask your MAVI care provider for information.