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Transcarotid Artery Revascularization (TCAR) is a hybrid minimally invasive procedure designed to treat carotid artery stenosis by combining:

• Direct carotid access through a small neck incision, and
• Dynamic cerebral protection using temporary flow reversal during carotid stenting. </aside>

It aims to reduce the embolic stroke risk typically associated with transfemoral carotid stenting (CAS), while avoiding the invasiveness of carotid endarterectomy (CEA).

Etiopathogenesis

• Atherosclerotic narrowing at the carotid bifurcation causes embolic strokes via plaque rupture and distal embolization.
• TCAR is used for stroke prevention in patients with significant carotid stenosis, particularly those at high risk for open surgery.

Indications

TCAR is approved for symptomatic ≥70% or asymptomatic ≥80% stenosis (NASCET criteria) in patients considered high surgical risk, such as:

• Age >75 years
• Previous neck surgery or radiation
• Hostile neck anatomy (high bifurcation, contralateral laryngeal palsy)
• Severe cardiac or pulmonary disease
• Restenosis after CEA

Contraindications

• Inability to tolerate flow reversal (e.g. contralateral carotid occlusion with poor circle of Willis collateralization)
• Unfavorable anatomy for carotid exposure
• Active infection or bleeding diathesis
• Acute stroke within 48 hours