Published on March 04, 2020

New Minimally Invasive Procedure at NMMC Prevents Stroke

Cardiovascular surgeons team grouped together smiling

Vascular surgeon Dr. Joey Stinson (front row, fourth from left) and cardiothoracic surgeon Dr, Vishal Sachdev (second from left) performed the first two TransCarotid Artery Revascularization (TCAR) cases at NMMC on Feb. 21.

TUPELO, Miss.—North Mississippi Medical Center recently became the first hospital in north Mississippi to use a new, less-invasive procedure called TransCarotid Artery Revascularization (TCAR) to safely reduce the risk for stroke in patients with blocked carotid arteries but considered too risky for traditional surgery.  

Vascular surgeon Joey Stinson, M.D., and cardiothoracic surgeon Vishal Sachdev, M.D., performed the first two cases at NMMC on Feb. 21. The procedure lowers patients’ risk for stroke with faster recovery, less pain and smaller scars.

Blocked carotid arteries occur when plaque builds up in the main blood vessels to the brain. Eighty percent of strokes are “ischemic strokes,” where part of the circulation to the brain is cut off, usually by blockages in the carotid arteries.

TCAR is an important new option to prevent stroke. “This procedure is particularly suited for the large portion of patients we see who are at higher risk of complications from carotid surgery because of age, anatomy or other medical conditions,” Dr. Stinson said. “We perform the procedure through a much smaller incision at the neckline just above the clavicle instead of a longer incision on the neck.”

Traditionally, surgeons relied on two main types of procedures: carotid endarterectomy and carotid stenting. In carotid endarterectomy, the surgeon removes the plaque from the artery through a neck incision then repairs the artery using a graft from vein elsewhere in the body or a woven patch. Carotid stenting is a minimally invasive procedure where the surgeon places a small, expandable tube called a stent in the narrowed artery.

While any repair of the carotid artery carries some risk of causing a stroke because of the repair itself, TCAR was designed to help minimize that risk. “TCAR is unique in that blood flow is temporarily reversed during the procedure so that any small bits of plaque that may break off are diverted away from the brain, preventing a stroke from happening,” Dr. Sachdev said. Surgeons then filter the blood before returning it to a vein in the groin and implant a stent directly into the carotid artery to stabilize the plaque and prevent future strokes. Patients stay overnight in the hospital and recover quickly.

The TCAR procedure was developed by Sunnyvale, California-based Silk Road Medical Inc., and more than 10,000 cases have been performed worldwide through clinical trial and commercial use. For more information, visit www.nmhs.net/vascular or call Cardiothoracic and Vascular Surgery Clinic at (662) 377-7170 or 1-800-THE DESK (1-800-843-3375).

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