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NEWS | Dec. 19, 2017

TransCarotid Artery Revascularization procedure used for first time at Brooke Army Medical Center

By Lori Newman Brooke Army Medical Center Public Affairs

Brooke Army Medical Center took a leap forward for military vascular surgical care Oct. 4 when surgeons performed a TransCarotid Artery Revascularization procedure, marking the first time this procedure to reduce carotid artery stenosis has been used at BAMC.

The TCAR procedure is more commonly used in the civilian sector, but it was recently approved for use within the military health care system, explained Army Lt. Col. (Dr.) Shane McEntire, a vascular surgeon at BAMC, who performed the procedure.

“This was the first time this procedure was used at Brooke Army Medical Center,” McEntire said. “And, I believe this may be the first time the procedure was done in the military health system.

“Surgeons must be specially trained or assisted by someone who has been trained on the device used during the procedure before they can do this surgery,” the doctor said.

The patient, Christine Kruithof, had heard about the procedure before, so she was not leery about it.

TCAR uses a small incision at the neckline that is smaller than a carotid artery endarterectomy, the surgery normally used to clear carotid artery stenosis.

Narrowing or stenosis of the carotid arteries occurs when plaque builds up and the carotid arteries begin to constrict. This can slow the blood flow to the brain, possibly causing a stroke.

There are four treatment options for patients with carotid artery stenosis: diet modification and exercise, medical management with prescription medications, carotid artery endarterectomy or transfemoral carotid artery stenting.

“Historically the way we treat carotid artery disease or blockage of the artery is with surgery,” McEntire said.

“This procedure is for people whose physician deems them high risk for a traditional surgery. This is an alternative to the transfemoral stenting which has a greater stroke risk,” McEntire said. “The whole point is to decrease the risk of a stroke.”

During the procedure, the surgeon temporarily places a tube directly into the carotid artery. The tube is connected to a system that temporarily directs blood flow away from the brain to protect against particles that may break loose during the procedure. The particles may be captured in a filter as blood is returned through a tube placed in the upper leg.

While the blood flow is reversed, a stent is placed at the area of the blockage. The stent holds the artery open to allow normal blood flow to the brain. After the stent is successfully placed the reverse flow is turned off and the blood flow resumes its normal direction.

“Several research studies have shown the TCAR procedure demonstrated a reduction in embolization to the brain,” McEntire said.

“I was confident about the procedure,” Kruithof said. “Dr. McEntire and his team are absolutely terrific.”

“I recuperated really fast,” she added.