Transcarotid Artery Revascularization (TCAR) at St. Luke’s
Stroke patient Gloria Wright consults with Dr. Mark Eginton, vascular surgeon at St. Luke's, about the TCAR procedure.
Nearly 16 years after her first stroke, Gloria Wright found out that she was in danger of having another. The carotid artery on her left side was once again becoming clogged with plaque. If her doctors didn’t intervene, pieces of this hardened, wax-like substance could break off and make their way to her brain, putting her life in jeopardy.
This condition, known as carotid artery disease, is typically treated with an endarterectomy. For some patients though this traditional open surgery can be risky, and at almost 90 years old this was the case for Gloria.
Fortunately, there is now an alternative procedure. Transcarotid Artery Revascularization (TCAR) clears blockages in a less-invasive way and serves those who are not good candidates for an endarterectomy. As the only hospital north of the Twin Cities that offers this procedure, St. Luke’s can now offer patients like Gloria another option for treatment.
The traditional surgery: endarterectomy
During an endarterectomy, the carotid artery is accessed through a long incision in the neck. Blood flow is re-routed, the artery is opened and plaque is removed.
“One of my patients described it as making a slice in a banana, scooping out the meat and sewing the peel back together,” St. Luke’s Vascular Surgeon Dr. Mark Eginton said. This is the best option if the affected artery has a lot of blockage, or if the plaque is especially hardened.
After Gloria’s first stroke, this is how her carotid artery disease was addressed. “I have a scar from my ear to my shoulder from that first surgery,” Gloria explained. “I’d never been through anything like that before, but I knew it had to be done.”
Every six months since her endarterectomy, Gloria checks in with her doctor. It was at one of these check-up appointments that Dr. Eginton became concerned with the amount of he saw building up again. Dr. Eginton let her know that something would have to be done, and that another endarterectomy was not going to be the best option for her.
TCAR: offering another solution
Some patients are not good candidates for the traditional surgery. This includes those who have a blockage of more than 70%, have already had an endarterectomy or those who aren’t in good enough health to undergo open surgery. For this group of people, TCAR offers another way to address blockage without the risks that come with an endarterectomy.
To perform TCAR, a small incision is made near the collar bone and a tube is placed into the artery. Through that tube, the vascular surgeon perform an angioplasty, inflating a tiny balloon inside the artery to widen it. Then, the balloon is removed and a stent is placed that acts as scaffolding to keep the artery open.
One of the main benefits of TCAR is the protection it offers against strokes during the procedure. Normally with angioplasty and stenting, blood would flow from the surgery site to the brain. This means that if a piece of plaque comes loose, the patient would be at risk of having a stroke.
With TCAR, a device is used to reverse the blood flow and prevent this from happening. The blood is then run through a small filter, removing any pieces of plaque disturbed during the process.
“This system for preventing strokes during the procedure was a deal breaker in whether or not we’d do it at St. Luke’s,” Dr. Eginton said. “Once the studies showed good outcomes for over 10,000 patients, I got on board.”
More options, better results at St. Luke’s
Dr. Eginton successfully addressed Gloria’s carotid artery disease with TCAR. After her experience, she is quick to recommend Dr. Eginton and St. Luke’s. “I’ve been treated very well at St. Luke’s,” she said. “Dr. Eginton is just so kind. I really appreciate the way he treats people. The staff that works with him is also very nice to me, but I can’t say enough about him. I’d recommend anybody go see him.”
Dr. Eginton is proud to work for a health care system that enables more options for his patients. “It says a lot about St. Luke’s as an organization that we’re willing to do this,” he said. “The cost for an endarterectomy is less expensive. We are making a lot less money with TCAR, but because it can benefit some of our patients, we are now offering it.”
While this procedure is a helpful alternative for some, it does not replace the traditional endarterectomy. “About one third of people are good candidates for TCAR. Two thirds would still be better served by the traditional surgery,” Dr. Eginton explained. “However, now we have options. We can choose whichever one is best for each patient.”
To learn more about St. Luke’s Vascular Surgery Associates and the services they offer, visit slhduluth.com/VascularSurgery.
This article was published in the Woman Today magazine December 2019-January 2020 issue.