Transcarotid artery revascularization (TCAR): Overview
Transcarotid artery revascularization (TCAR) is a procedure to open a narrowed carotid artery. This is done by placing a tiny expandable tube (stent) in the artery. There are two carotid arteries, one on each side of the neck. They supply blood to the brain. Fatty buildup (plaque) can narrow these arteries and limit blood flow to your brain. The plaque also raises your risk of stroke. TCAR may improve blood flow to your brain and lower your risk of stroke.
You will get medicine to block pain and make you relax or sleep. Then the doctor will make a small cut (incision) above your collarbone. The doctor will insert a thin tube (catheter) into the carotid artery. Blood flows through the catheter to a filter. This catches any bits of plaque that might break off and keeps them from moving to the brain. The filtered blood is returned to the body through a catheter inserted into a blood vessel in the groin.
Next, the doctor will move a balloon and a stent into the narrow section of the carotid artery. The balloon is inflated inside the stent. This opens the stent and pushes it into place against the artery wall. The balloon is then deflated.
The doctor will remove the balloon. The stent will stay in your artery. Over time, the cells lining the artery will grow through and around the stent to help hold it in place.
The filter system is turned off, and blood flow is returned to normal. Then the doctor will remove the catheter and close the incision.
You may stay at least 1 night in the hospital.
After transcarotid artery revascularization (TCAR): When to call
Call 911 anytime you think you may need emergency care. For example, call if:
- You passed out (lost consciousness).
- You have severe trouble breathing.
- You have a tight bulge in your neck on the side where the incision was made.
- You have symptoms of a stroke. These may include:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
- You have symptoms of a heart attack. These may include:
- Chest pain or pressure or a strange feeling in the chest.
- Sweating.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
Call your doctor now or seek immediate medical care if:
- You are bleeding from the area where the catheter was put in your groin.
- You have a fast-growing, painful lump at the catheter site.
- Your leg is painful, looks blue, or feels cold, numb, or tingly.
- You have pain that does not get better after you take pain medicine.
- You have loose stitches, or your incision comes open.
- Bright red blood has soaked through the bandage over your incision.
- You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness of the skin.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.
How do you prepare for transcarotid artery revascularization (TCAR)?
Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.
Preparing for the procedure
- Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
- Understand exactly what procedure is planned, along with the risks, benefits, and other options.
- If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
- Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
- Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
How can you care for yourself after transcarotid artery revascularization (TCAR)?
Activity
- If the doctor gave you a sedative:
- For 24 hours, don't do anything that requires attention to detail, such as going to work, making important decisions, or signing any legal documents. It takes time for the medicine's effects to completely wear off.
- For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
- Do not do strenuous exercise and do not lift, pull, or push anything heavy until your doctor says it's okay. This may be for several days. Try not to walk up stairs for the first couple of days. You can walk around the house and do light activity, such as cooking.
- If your doctor recommends it, be active. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
- Ask your doctor when you can drive again.
- Your doctor will tell you when you can have sex again.
- Carry your stent identification card with you at all times.
Diet
- You may notice that your bowel movements are not regular right after your procedure. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
- Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
- Keep eating a heart-healthy diet that has lots of fruits, vegetables, and whole grains. If you need help with your diet, talk to your doctor. You also may want to talk to a dietitian. This expert can help you learn about healthy foods and plan meals.
Medicines
- Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
- If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
- Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
- Your doctor may prescribe a blood thinner such as aspirin. It is important that you take these medicines exactly as directed to help reduce your risk of a stroke. Be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.
Care of the groin catheter site
- For 1 day or for as long as your doctor recommends, keep a bandage over the spot where the doctor put the catheter in your groin.
- Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
- You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
- Do not soak the catheter site until it is healed. Don't take a bath for 1 week, or until your doctor tells you it is okay.
- Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
- If you are bleeding, lie down and press on the area for 15 minutes to try to make it stop. If the bleeding does not stop, call your doctor or seek immediate medical care.
Incision care
- If you have strips of tape over your incision, leave the tape on for a week or until it falls off.
- You may shower and take baths as usual. But do not soak the incision for the first 2 weeks, or until your doctor tells you it is okay. Pat the incision dry.
- Wash the area daily with water and pat it dry. Don't use hydrogen peroxide or alcohol. They can slow healing. You may cover the area with a gauze bandage if it oozes fluid or rubs against clothing. Change the bandage every day.
- Keep the area clean and dry.
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