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New Minimally Invasive Endovascular Procedure Reduces the Risk of Stroke
When Kevin McDermott was diagnosed with carotid artery stenosis nine years ago, he was stunned. “I felt perfectly fine,” he says. “I had no symptoms and absolutely no idea that I had such a serious condition.”
Carotid artery stenosis is a narrowing of the large arteries on either side of the neck that carry blood to the brain. Usually, the result of a build-up of plaque within the arteries, a condition called atherosclerosis, stenosis can worsen over time to completely block the artery. Blockages of carotid arteries in the neck are responsible for a large percentage of strokes.
McDermott’s doctors performed a carotid endarterectomy, a procedure that involves the surgical removal of the plaque. The surgery was a success and McDermott resumed his normal activities, adding twice-yearly checkups with his doctor to his schedule.
Then, late last year during a routine follow-up scan, his doctor discovered that he was experiencing a rapid recurrence of the condition. Once again, he was taken by surprise. â€œIt had been nine years since my first surgery and I thought I was in good health,” says McDermott, who had just celebrated his 75th birthday.
He was then referred to Raghuveer Vallabhaneni, MD, FACS, director of Vascular Surgery, Baltimore Region at MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital. After further evaluation, Dr. Vallabhaneni suggested a new method of carotid stenting as the most appropriate means of treatment.
“A second conventional open carotid artery endarterectomy would have put Kevin at greater risk for nerve damage and stroke, given the likely presence of scar tissue from the earlier procedure,” Dr. Vallabhaneni says.
"Carotid artery stenting is a less invasive approach for re-opening blocked arteries that is a good option for patients who are high-risk candidates for surgery. However, the traditional transfemoral approach from the groin also has its risks and can result in complications," he notes.
Dr. Vallabhaneni recommended a stent procedure he believed was a more suitable option for McDermott—a minimally invasive transcarotid artery revascularization (TCAR).
“During TCAR, blood flow is temporarily directed away from the brain, protecting it from any embolic debris that might be created during the procedure,” explains Dr. Vallabhaneni, one of only a handful of surgeons in Maryland performing TCAR, which was approved by the FDA just two years ago. “This reduces the risk of stroke by preventing particles that may come loose from reaching the brain.”
A CT scan confirmed that McDermott was a good candidate for the TCAR stent procedure. He was advised of the benefits and risks and decided to move forward with the procedure. The TCAR was performed under general anesthesia through a small incision at his neckline just above his clavicle. No problems or unexpected conditions were encountered, and McDermott was discharged the day after surgery. A follow-up scan verified that the stent was performing as expected, with no recurrence of stenosis.
McDermott considers himself extremely fortunate that the blockage was found…both times. “The fact that you can feel perfectly fine yet be a prime candidate for a stroke is scary.” He continues to undergo routine monitoring.
“TCAR offers tremendous promise for the treatment of carotid artery stenosis as an alternative to conventional carotid endarterectomy and stenting procedures,” Dr. Vallabhaneni adds. “Indeed, it has the potential to become a primary therapy for carotid artery stenosis, a trend that will benefit both patients and surgeons.”