Posted on May 18, 2017

PCI Vascular Surgeons First in Eastern Iowa to Perform TCAR Procedure

Every year, nearly 15 million people across the globe suffer a stroke. Of those, close to 6 million die and another 5 million are left permanently disabled. In fact, strokes are the second leading cause of disability worldwide.

Approximately 20 to 30 percent of strokes are caused by blockages of the carotid artery, which supplies oxygenated blood to the brain. When the arteries become blocked with plaque build-up, an individual is considered at high risk for a stroke. Some people can manage the disease with medications and lifestyle changes. Others need surgical intervention.

“In the past, carotid endartectomy was the gold standard of intervention for people with blockages,” said David Lawrence, MD, FACS, lead vascular surgeon at Physicians’ Clinic of Iowa, in Cedar Rapids. “Carotid endartectomy involves clamping the artery above and below the blockage, then removing the plaque. Small filters placed in the arteries help to capture the loosened debris before the blood recirculates to the brain. However, these filters could never guarantee that microscopic particles wouldn’t travel to the brain and cause an infarction.”

PCI vascular surgeons are the first in eastern Iowa to begin performing the new Transcarotid Artery Revascualrization (TCAR) procedure, a safer, minimally invasive surgery that shows promise for patients with the highest risk of stroke.

“The TCAR procedure involves stenting to stabilize the plaque within the artery, rather than removing the plaque and risking causing a stroke,” Dr. Lawrence said. “The stent is delivered via a small incision in base of neck to allow direct access to the carotid artery.

“However, the biggest difference with this surgery is neuroprotective flow reversal during delivery of the stent,” Dr. Lawrence continued. “When the carotid is accessed, a sheath is placed in the artery and connected to a system that reverses the flow of blood away from the brain. This protects against fragments of plaque that might come loose during the procedure.”

The blood is filtered and returned through a second sheath placed in the femoral vein in the patient’s thigh. After the stent is placed, flow reversal is turned off and the flow of blood resumes in its normal direction.

“This advanced approach provides high risk stroke patients with another, probably safer, treatment option,” Dr. Lawrence said. “Our vascular team is proud to be able to bring these advanced treatments to people in eastern Iowa.”

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