NHRMC Offers Minimally Invasive Procedure to Reduce Stroke Risk

March 29, 2019
TCAR blog photo

Gary Sunderland was recovering from a heart procedure at New Hanover Regional Medical Center when a physician assistant stopped by to assess him. Using a stethoscope, the physician assistant listened to the carotid artery in his neck.

She didn’t like what she heard.

He got a referral to a vascular surgeon and discovered he had blockages in his carotid arteries, which carry oxygenated blood to the brain. His right carotid artery was 100 percent blocked, and his left was over 70 percent blocked.

Carotid artery diseases, which happen when plaque clogs the blood vessels, increase the risk of a stroke.

“It was like a ticking time bomb,” said Sunderland, who is 81 and has enjoyed good health all his life.

The most commonly performed surgery to remedy blocked carotid arteries is a carotid endarterectomy, which involves a surgeon opening the artery to remove the plaque. This procedure is offered at NHRMC, but it is invasive and not ideal for everyone. 

After reviewing Sunderland’s case, Dr. Michael Patton, a Wilmington vascular surgeon, recommended a minimally invasive procedure to place stents in his carotid arteries, lowering his risk of stroke. Dr.

Patton placed the stents, which are small mesh tubes, using the TCAR procedure, which stands for transcarotid artery revascularization.

The procedure has been available about a year at NHRMC, and the four surgeons who perform it use the technique on about 50 to 75 patients annually. Other patients may be appropriate for another minimally invasive stenting technique that accesses the carotid artery by inserting a catheter in the femoral artery in the groin.

Using the TCAR technique, the surgeon makes a small incision at the base of the neck and inserts a sheath into the carotid artery. Via the sheath, blood flow is temporarily reversed to flow away from the brain and toward the femoral artery. During this time, other arteries continue to provide blood to the brain. After the stent is placed into the artery, blood flow is restored to its normal direction. This reversal prevents plaque that may have come loose during the procedure from traveling to the brain, which could trigger a stroke.

The TCAR technique is used for patients already at a higher risk for stroke, including individuals 75 years and older or those diagnosed with heart failure, COPD or lung disease, diabetes or who had prior radiation or surgery to the neck.

Sunderland was a good candidate for the procedure because of his age. He said the care he received at NHRMC’s Surgical Pavilion was phenomenal.

“You might almost say loving, the treatment I got there,” he said. “Especially in recovery.”

After receiving stents in arteries supplying his heart and brain with blood, he is now exercising without being short of breath.

“I’m appreciative of the skill of my doctor, the wonderful facilities and the staff there,” he said. “I’d recommend it to anyone.”

For more information on surgical services available at NHRMC, visit: https://www.nhrmc.org/services/surgery

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