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Transcarotid Artery Revascularization (TCAR): Before Your Procedure

Carotid artery on side of neck, with detail of inside the artery showing plaque limiting blood flow and detail of inserted stent improving blood flow.

What is transcarotid artery revascularization (TCAR)?

Transcarotid artery revascularization (TCAR) is a procedure to open a narrowed carotid artery. This is done by placing a tiny expandable tube (stent) in the artery. There are two carotid arteries, one on each side of the neck. They supply blood to the brain. Fatty buildup (plaque) can narrow these arteries and limit blood flow to your brain. The plaque also raises your risk of stroke. TCAR may improve blood flow to your brain and lower your risk of stroke.

You will get medicine to block pain and make you relax or sleep. Then the doctor will make a small cut (incision) above your collarbone. The doctor will insert a thin tube (catheter) into the carotid artery. Blood flows through the catheter to a filter. This catches any bits of plaque that might break off and keeps them from moving to the brain. The filtered blood is returned to the body through a catheter inserted into a blood vessel in the groin.

Next, the doctor will move a balloon and a stent into the narrow section of the carotid artery. The balloon is inflated inside the stent. This opens the stent and pushes it into place against the artery wall. The balloon is then deflated.

The doctor will remove the balloon. The stent will stay in your artery. Over time, the cells lining the artery will grow through and around the stent to help hold it in place.

The filter system is turned off, and blood flow is returned to normal. Then the doctor will remove the catheter and close the incision.

You may stay at least 1 night in the hospital.

How do you prepare for the procedure?

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

  • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
  • Understand exactly what procedure is planned, along with the risks, benefits, and other options.
  • If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
  • Tell your doctor ALL the medicines and natural health products you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
  • Make sure your doctor and the hospital have a copy of your advance care plan. If you don't have one, you may want to prepare one. It lets others know your health care wishes. It's a good thing to have before any type of surgery or procedure.

What happens on the day of the procedure?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be cancelled. If your doctor told you to take your medicines on the day of procedure, take them with only a sip of water.
  • Follow your doctor's instructions about when to bathe or shower before your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Take off all jewellery and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery centre

  • Bring a picture ID.
  • You will be kept comfortable and safe by your anesthesia provider. You may get medicine that makes you relax or sleep. The area being worked on will be numb.
  • The procedure may take about 1 to 2 hours.
  • After the procedure, pressure may be applied to the area where the catheter was put in your groin. This will help prevent bleeding. A small device may also be used to close the blood vessel. The area may be covered with a bandage or a compression device.
  • You will need to lie still and keep your leg straight for up to a few hours. The nurse may put a weighted bag on your leg to keep it still.
  • Your neck may be sore, and there may be a stitch where the doctor made the cut to insert the catheter.
  • Nurses will check your heart rate and blood pressure. The nurse will also check the catheter site for bleeding.
  • You may have a bruise or a small lump where the catheter was put in your groin. This is normal and will go away.

When should you call your doctor?

  • You have questions or concerns.
  • You don't understand how to prepare for your procedure.
  • You become ill before the procedure (such as fever, flu, or a cold).
  • You need to reschedule or have changed your mind about having the procedure.

Where can you learn more?

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