Transcarotid Artery Revascularization: How to Overcome Anatomical Boundaries With Prosthetic Conduit

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Innovation

Background:

• Carotid artery stenosis requires intervention, with transcarotid artery revascularization (TCAR) being a viable option for high-risk patients.
• Anatomic limitations like short common carotid artery (CCA) length or thrombus can prevent standard TCAR.
• Carotid endarterectomy (CEA) and transfemoral stenting are alternatives but may carry higher risks.

Purpose of the Study:

• To describe and evaluate a modified TCAR technique using a prosthetic conduit.
• To assess the feasibility and safety of this modification in patients with prohibitive anatomy for standard TCAR.
• To determine if this approach expands TCAR eligibility without compromising outcomes.

Main Methods:

• A prosthetic conduit (6 mm Dacron graft) was anastomosed to the CCA to create an extended runway.
• The TCAR sheath was introduced into the prosthetic conduit, facilitating safe access.
• Standard TCAR procedures were then completed, followed by conduit ligation and closure.

Main Results:

• The modified TCAR technique was successfully applied in three patients with challenging anatomy.
• Operative and flow reversal times were comparable to conventional TCAR procedures.
• No complications were observed in the patients who underwent this modified TCAR.

Conclusions:

• TCAR with a prosthetic conduit is a safe and effective modification for patients with inadequate CCA length or unfavorable anatomy.
• This technique broadens the patient population eligible for TCAR, potentially avoiding higher-risk interventions.
• The modification expands the vascular surgeon's toolkit, enhancing TCAR accessibility without compromising safety or efficiency.