PEORIA — A new treatment for carotid artery disease with a lowered risk of procedure-related stroke is being performed at UnityPoint Health-Methodist Hospital.
“Within the last month we performed the procedure on two patients,” said Dr. Scott Reid, a vascular surgeon. “Both patients have been seen in follow-up care and are doing very nicely. One of the patients is coming back later this month because she needs to do the other carotid artery.”
UnityPoint Health is the first hospital in central Illinois to offer transcarotid artery revascularization, or TCAR, a new method for placing a stent in a carotid artery narrowed by plaque buildup. It differs from an older stent procedure by utilizing a shorter route to the blockage and a new method for catching plaque, which may break off during the procedure. If not captured, plaque traveling through the carotid could cause a stroke.
“This procedure has been demonstrated in randomized clinical trials to have the lowest incidence of procedure-related stroke,” said Dr. Jan Namyslowski, a vascular and interventional radiologist. “That’s what distinguishes it from the pack.”
Accessing the blockage from the neck rather than the groin shortens the distance the stent has to travel to its destination, minimizing the chance of breaking off plaque along the way.
“One significant advantage of this procedure is, you can avoid plaque that sits in the aortic arch,” said Reid. “The other advantage is, the access we require is relatively small. You are talking a 3 centimeter-wide incision to gain access to the common carotid, and a puncture into the carotid. You close it with one stitch to the carotid and a couple stitches in the neck.”
Another advantage of TCAR is the innovative device designed to catch loosened plaque. Using the body’s own natural pressure system, the device actually reverses the flow of blood in the artery, sending it through a filter and back into a vein in the patient’s leg.
“The benefit to the flow reversal system is that you are not having to put a filter past the blockage,” said Reid, referring to the umbrella-like device used during a standard carotid stent procedure. “Part of the risk of putting a filter across the blockage is that something might break off while you are in the process of doing this.”
TCAR generally takes about an hour. Patients stay in the hospital overnight and go home the following day.
While TCAR is a great option, it’s not right for everyone.
“This is not something that fits all. There are factors that might make one patient a candidate for this, and another patient a candidate for a different procedure,” said Namyslowski.
Several physiological factors may make a patient ineligible for TCAR.
“You might have a landing zone that is too short for TCAR,” said Reid. “We need a long enough distance between where we enter the carotid and where the plaque is. You have to have enough working room to put the device in.”
Carotid artery disease generally strikes people older than 50. The easiest way to detect it is to ask your doctor to put a stethoscope on your neck, said Reid.
“If there is narrowing, your doctor will hear a swishing sound,” he said. An ultrasound will determine how severe the narrowing is. If the disease is more advanced, the patient have mini-stroke symptoms.
“Those would be episodes of facial droop, slurred speech, one side of your face or body going weak, and there could be vision changes,” said Reid. Though these symptoms might be fleeting, they are a red flag.
“The medical term is transient ischemic attack,” said Namyslowski. “Don’t ignore it.”
Patients with minimal disease are treated with blood thinners. Patients who need surgical interventions could be offered carotid endarterectomy, where the artery is cut open and the blockage is removed, or angioplasty and stenting. Doctors may recommend placing a stent through the groin or with the TCAR procedure, depending on what tests show. Patients go through a battery of tests to determine which procedure is right for them. In the end, they sit down with their doctors, who explain the results and recommend a course of treatment, said Namyslowski.
The doctors at UnityPoint Health-Methodist have no idea how many TCAR procedures they will be performing in the future, but they are happy to have another weapon in the fight against carotid artery disease, a leading cause of stroke.
“We have 500,000 strokes a year in the U.S., and 10 to 20% are related to carotid artery disease,” said Namyslowski. “That’s a significant amount. And that number will continue to rise with an aging population.”
Leslie Renken can be reached at 686-3250 or firstname.lastname@example.org. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.