Transcarotid Artery Revascularization (TCAR) using a micromesh technology Stent without blood flow reversal

Abstract

Background

Transcarotid Artery Revascularization (TCAR) is a technique in which a stent is placed in the internal carotid artery (ICA) by directly puncturing the common carotid artery (CCA). This technique allows stent implantation in situations, such as extreme arch pathologies and/or previous surgery or radiation, where classic stenting and endarterectomy of the internal carotid artery would be associated with a high risk of complications. We present a clinical case of TCAR technique using the dual-layer micromesh stent without the use of blood flow reversal.

Case

A 75-year-old patient was diagnosed with a 90 % (The North American Symptomatic Carotid Endarterectomy Trial – NASCET) asymptomatic stenosis of the internal carotid artery (ICA) on the right side. On the same side of the neck, an extended tonsillectomy with partial resection of the pharynx and the base of the tongue was performed 13 years ago due to tonsil cancer. Due to the postoperative extremely scared tissue and unfavorable anatomical conditions, carotid endarterectomy and classic stent implantation were not feasible. Therefore, we performed the TCAR procedure with the implantation of a micro mesh stent to reduce the risk of peripheral embolization without blood flow reversal. The procedure was successful, and the patient was discharged on the third day after surgery.

Conclusion

The TCAR procedure is a viable alternative for patients for whom carotid endarterectomy or carotid stent implantation poses too high a risk which adds to the armamentarium of techniques in carotid revascularization. The use of a stent with micro mesh technology may enhance the safety of this procedure.