A stroke occurs when a part of the brain loses its blood supply and stops working. This will then cause the part of the body that the injured brain controls to stop working as well.
Approximately 795,000 people in the United States will have a stroke each year, according to the American Stroke Association.
The most common type of stroke is an ischemic stroke, which accounts for 80 percent to 90 percent of strokes. An ischemic stroke is when the arteries to the brain become so narrowed or blocked that the blood flow is severely reduced. An estimated 20 to 30 percent of ischemic strokes are caused by disease in the carotid arteries.
The carotid arteries, the main arteries to the brain, carry blood flow on each side of the neck up into the brain. Their function is to provide oxygen.
Over time, some people develop problems with the arteries to their brain in the form of blockages as plaque builds up in the walls of their carotid arteries. This plaque consists of cholesterol, calcium and fibrous tissue. As the plaque increases inside the arteries, eventually the buildup reduces the blood flow through the arteries. If those blockages get severe enough, they can cause a stroke.
Carotid artery disease is a serious issue, because blood clots can form on the plaque, and if a clot or a piece of plaque breaks loose and travels to the brain, it can block the blood flow to that portion of the brain.
Carotid endarterectomy is a procedure performed by a vascular surgeon to treat carotid artery disease. During this procedure, the vascular surgeon exposes the carotid artery through an incision on the side of the neck. The artery, after being clamped on both sides of the blockage, is then opened to access the plaque. The plaque is removed from inside the artery and the artery is then sewn back together.
This is an effective treatment for decreasing the risk of stroke. However, some patients have medical conditions that place them at high risk for carotid endarterectomy.
For these patients, a procedure called transcarotid arterial Rrevascularization (TCAR) is available. During the procedure, the vascular surgeon makes a very small, one-inch incision just above the collarbone to gain access to the blocked artery while the patient is under local anesthesia.
TCAR is a more viable option for patients who have medical conditions that would prohibit them from undergoing an open procedure such as the carotid endarterectomy.
To divert any dangerous debris that might break loose during the procedure, the blood flow in the carotid artery is temporarily reversed. A soft, flexible tube, placed directly into the carotid artery, connects to a filter system that directs the blood flow away from the brain and captures small pieces of plaque that might come loose during the procedure. The blood is filtered and returned through a second tube placed in the patient’s thigh.
This filter system also allows stenting to be performed to clear the blockage in the carotid during the blood flow reversal process. A stent, a tiny mesh wire tube, implanted inside the carotid artery, stabilizes the blocked area. The stent stays in the artery permanently to hold the artery open. After securing the stent, the filter system is removed, and blood flow to the brain resumes its normal direction.
Recovery time for this procedure is short since the incision is so small and generally is done with minimal anesthesia. The procedure requires an overnight stay in the hospital and most patients return to their normal activities within a week.
In 2017, with McLeod already having an established Carotid Stenting Program and serving as members of the Vascular Quality Initiative for South Carolina, the FDA was approving and releasing the TCAR technology to programs like the McLeod Heart and Vascular Institute. McLeod was fortunate to have been selected as the first class of surgeons in South Carolina to complete the FDA training.
Recently, the two teams who perform TCAR for McLeod were recognized nationally for their high patient outcomes, superb procedural techniques of the vascular surgeons and the excellent patient care they provide. Silk Road Medical, the developers of this procedure, awarded the TCAR Centers of Excellence to the McLeod Regional Medical Center and McLeod Health Seacoast. The hospitals were recognized as the top two heart and vascular centers for this stroke prevention procedure in the state of South Carolina. With a low stroke risk and a faster patient recovery, TCAR and McLeod represent the future of carotid repair.
Dr. Eva Rzucidlo is a board-certified vascular surgeon with additional vascular research fellowship training. She cares for patients at McLeod Vascular Associates in Florence, Hartsville, Sumter and Cheraw. For information on scheduling appointments, call 843-777-7043.