Transcarotid Artery Revascularization (TCAR)

With carotid artery disease, a waxy substance (plaque) builds up in neck blood vessels that supply the brain. Severe blockages can cause a stroke, but you don’t have to live in fear of this risk.

At Virginia Mason Franciscan Health, you have access to leading therapies, such as transcarotid artery revascularization (TCAR). This minimally invasive procedure safely treats blockages in the carotid arteries and reduces your stroke risk. It involves innovative techniques and real-time imaging to deliver treatment through a tiny neck incision.

You receive services from vascular surgeons with advanced (fellowship) training and years of experience treating complex carotid artery disease. We perform a high volume of TCAR procedures and maintain very low complication rates. This level of care is not widely available in the Puget Sound. Meet our team.

Highlights of our program include:

• Personalized approach: We often use nonsurgical therapies for early-stage carotid artery disease. Sometimes, the path forward, like whether a TCAR procedure is necessary, isn’t clear. We discuss the risks and benefits of waiting and, together, develop a treatment plan you feel good about.

• Appropriate therapies: Our doctors measure carotid artery narrowing to determine its severity so that you receive timely treatment. If there is a higher stroke risk, we consider whether TCAR or open surgery (carotid endarterectomy) is best for your needs. 

• Comprehensive care: Virginia Mason Franciscan Health offers all the services you need in one program, including evaluations, treatment and ongoing monitoring. We also have an accredited vascular testing lab where we accurately measure carotid artery narrowing. After TCAR, ongoing monitoring protects your long-term vascular health.  

• Convenience: TCAR treats carotid artery narrowing but does not cure it. After recovery, you may be eligible for annual vascular health checkups via virtual visits. You go to one of our six vascular testing sites for an ultrasound, then review results online with one of our doctors

This procedure is for people with carotid artery disease and:

• Severe narrowing and no symptoms
• Moderate narrowing with symptoms of stroke or mini-stroke

It’s also for people who cannot undergo open surgery for carotid artery disease due to:

• Advanced age
• Re-stenosis, which occurs when carotid artery narrowing comes back after surgery
• Narrowing in both carotid arteries
• Unstable heart disease or other chronic issues, like uncontrolled diabetes

We explain the risks and benefits of TCAR and let you know if it’s right for you.

You receive general anesthesia so that you stay comfortable during the procedure. After making a small incision near your collarbone, surgeons slide a small tube (catheter) along the carotid artery that helps them carry out the treatment. 

A special machine temporarily reverses blood flow away from the brain while treating the blockage. Doing so prevents plaque that comes loose from traveling to the brain during the procedure. Surgeons then place a hollow mesh device (stent) in the carotid artery blockage. It pushes the blockages out of the way, allowing blood to flow more freely through the vessel. 

You will likely go home the day after your transcarotid artery revascularization procedure. Even if treatment goes as expected, you may still be at risk for carotid artery disease or other vascular disease issues. We perform periodic monitoring, such as ultrasound scans, in our accredited vascular lab to optimize your vascular health.

Learn more about testing and treatment in the Puget Sound.