A Modified Transcarotid Artery Revascularization Technique for High-Risk Carotid Stenosis

Although transcarotid arterial revascularization (TCAR) may offer several advantages, the first commercial TCAR system (EnRoute; Boston Scientific, Marlborough, Massachusetts) is not available in many countries. Therefore, a suitable and simple technique for transcarotid treatment of high-risk carotid stenosis is needed.

We report a hybrid approach to carotid stenosis treatment: stenting with surgical exposure of the carotid artery, forming a flow reversal circuit, with a feasibility to add a distal filter. Sheaths are placed in the carotid artery and femoral vein to accomplish cerebral protection, forming a flow reversal circuit. In addition, a distal filter device was placed for cerebral protection. Technical success was achieved and the patient experienced no complications.

Our modified TCAR technique may be effective in patients with high-risk carotid stenosis.Clinical ImpactThis research work is aimed at high-risk patients with carotid artery stenosis who need surgical treatment. When there are no commercialized devices similar to Tcar but surgical treatment is urgently needed, This modified surgical approach can be adopted to reduce the incidence of ischemic stroke caused by intraoperative embolus detachment. The innovative significance of this research lies in using local materials and simple, practical instruments to reduce the risk of stroke caused by embolus detachment during surgery.