Reversing Course: A Procedure that Temporarily Reverses Blood Flow May be Key to Stroke Prevention for Some

Diabetes. High blood pressure. A history of smoking. Each of these conditions raise your risk of carotid artery disease, one of the most common causes of ischemic stroke.

“Carotid artery disease involves fatty plaque clogging the arteries in your neck that deliver blood to your brain,” said Emaad Farooqui, M.D. a vascular surgeon at Hoag. “Your doctor may recommend surgery to clear the blockage and restore proper blood flow to your brain, reducing your risk of stroke.”

Surgical options include removing fatty deposits through a traditional open surgery called carotid endarterectomy (CEA) or through a minimally invasive procedure called carotid artery stenting (CAS). The Jeffrey M. Carlton Heart & Vascular Institute at Hoag offers Orange County patients another minimally invasive approach to reducing stroke risk, transcarotid artery revascularization (TCAR).

In TCAR, your surgeon will make a small incision into the carotid artery (above the collar bone) into which the surgeon uses a stent (a small, expandable tube) to open up the narrowed artery. During the procedure, the carotid artery blood flow is temporarily reversed to divert any plaque that may break off during the surgery away from the brain. “By reversing blood flow, we significantly reduce the risk of stroke during the stenting procedure,” Dr. Farooqui said. “This potentially life-saving technique opens the possibility of surgery for people at a higher risk of complications from carotid endarterectomy due to age, prior surgery, anatomy or other conditions.”

Recovery: Most people go home the day after a TCAR procedure and are asked to limit their activities for at least a week. “Pain is minimal for these patients,” Dr. Farooqui said. “Your doctor will likely recommend aspirin and other medications to prevent clots following surgery.”

Success Rates: TCAR is associated with a higher success rate and a lower risk of complication during surgery than traditional surgical options. That said, choosing surgeons – and a hospital – with a high-level of expertise is critical. “Hoag is on the leading edge of minimally invasive, vascular surgery,” Dr. Farooqui said. “Our team is among the most experienced, and experience is the key to success.”