Medically Reviewed by Christopher G. Cunningham, MD

When trying to open the clogged carotid arteries in the neck, traditionally there was a danger of debris breaking off and going to the brain, because that’s the direction arterial blood is flowing. But now there’s a big changes in that direction – literally. McLeod Vascular Surgeon Dr. Christopher Cunningham explains.

Here’s a summary of Dr. Cunningham’s explanation:

The carotid arteries are the main arteries to your brain. They carry blood flow on each side of the neck up into the brain to provide oxygen that allows you to think and do all the other marvelous things that the brain does.

People develop problems with the arteries to their brain and over time can develop blockages in the neck. If those blockages become severe enough, they can cause a stroke or brain attack. These typically occur as the arteries become narrowed and are filled with plaque. The artery becomes very narrow, forcing blood to use increased pressure to get through a little pinhole opening. This force tends to break off a piece of the plaque, which can travel to the brain. The little pieces that break off and go to the brain are called emboli, which is why it’s called an “embolic stroke.”

We have a new procedure in caring for people that have tight narrowing of the artery to their brain or even have had a stroke from that area. It’s called TCAR (pronounced Tee-car) or TransCarotid Arterial Revascularization.

Previously, when I had to fix the artery to a brain with surgery, I made a significant incision on the neck, then controlled the blood vessels above and below the blockages. Those little manipulations can create a risk of breaking off small pieces and causing a stroke. Traditional surgery is a wonderful operation and has good results, but it also requires the use of a general anesthetic, where you go to sleep and have a breathing tube placed in your windpipe.

TCAR is very exciting, because it can be done under local anesthesia with some moderate sedation. Patients are given medicine so they are relaxed but sleepy, yet able to follow simple commands. Then, at the collar line, I make a very small incision. Through that incision, I go to a section of the artery that is beyond the blockage. There I’m able to put in a small tube, kind of like an IV, and through that I’m able to reverse the blood flow from flowing towards the brain. It will now flow backward through the little sheath that I’ve inserted.

Whenever you operate on the artery to the brain, normally blood’s flowing toward the brain. If you touch it, handle it, or something is loose and breaks off, it goes to the brain and you have a stroke. If you are able to reverse the flow, you can put in a stent or balloon to clear the blockage, nothing is flowing toward the brain, and the risk of stroke has been lowered.

When the blockage has been cleared, I simply can remove the tube, put in one small stitch for closure. People are wide-awake, sitting up, going to recovery, and discharged the next morning.

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