TCAR: Unclogging Carotid Arteries


PHILADELPHIA, Pa. (Ivanhoe Newswire) — Each year, more than 300,000 people in the U.S. are diagnosed with carotid artery disease. If left unchecked, it can lead to stroke because tiny pieces of plaque break away and flow to the brain. Now, vascular surgeons are using a minimally invasive procedure to stent the carotid artery and prevent strokes: all done while the patient is still awake.

Strokes run in Frank Leuzzi’s family, so when doctors discovered a 90 percent blockage in his left carotid artery, he became a clinical trial patient for TransCarotid Artery Revascularization or ‘TCAR,’ for short.

“We do it completely under local. The patient is completely awake and we put the sheath directly into the carotid right through there on either side.” Paul DiMuzio, MD, FACS, William M. Measey Professor of Surgery, Director, Division of Vascular and Endovascular Surgery at Thomas Jefferson University Hospital told Ivanhoe. (Read Full Interview)

This groundbreaking procedure eliminates the need to go through the groin. Instead, surgeons use a small clavicle incision to implant the stent and open up blood flow.

“It’s still technically demanding. We have to be very careful not to cause any dislodging of the plaque. The way it protects the brain while we’re doing the stents is called flow reversal,” Dr. DiMuzio explained.

The stent is deployed and for patients like Frank, who lost his father to a stroke, it’s a quick lifesaving procedure. He was awake during the whole surgery and he recovered very quickly.

“This new procedure within a week, week and a half; he was totally back to normal. He never complained of being in pain and didn’t even take Tylenol. You feel better so much faster. I see how my dad did and it’s wonderful.” Frank’s Daughter, Marianne Leuzzi Rossini told Ivanhoe.

The FDA approved TCAR last year after testing at 30 centers around the country. It’s important to know that signs of a stroke include a change in vision or speech and weakness on one side of the body.  It typically occurs in older adults and strokes do run in the family.

Contributors to this news report include: Cyndy McGrath, Supervising Producer; Donna Parker, Field Producer; Kirk Manson, Videographer; Gabriella Battistiol, Assistant Producer; Roque Correa, Editor.

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REPORT:       MB #4298

BACKGROUND: Every year, 800,000 people have a stroke. There is at least one occurring every 40 seconds. Strokes occur due to problems with obstructed blood supply in the brain. This leads to the brain tissue dying. There are three types of strokes: ischemic, hemorrhagic, and transient ischemic attacks (also referred to as mini-strokes).  Ischemic strokes are caused by a narrowing of arteries to the brain. Hemorrhagic strokes are caused by blood vessels in and around the brain bursting. Strokes need to be treated immediately to minimize brain damage.


TREATMENT: One life-saving treatment is thrombectomy. This procedure uses a wire-cage device called a stent retriever to remove a large blood clot. This consists of a catheter being threaded through an artery in the groin up to the blocked artery in the brain. The stent opens and grabs the clot, and the stent is removed with the trapped clot. This procedure should be done within six hours of acute stroke syndromes.  Another procedure is carotid endarterectomy and it is done to remove blockage in the artoroid artery (which is common after a stroke).  The process includes the surgeon making an incision in front of the neck to remove the plague. The surgeon then repairs the artery with stitches in a natural graft from a piece of a vein and it is then woven into place. Patients will have symptoms such as a sore throat and a numb neck after surgery. The risks that come with this procedure are stroke, heart attack, and nerve damage.


NEW OUTLOOK: The TCAR is a small incision made above the collar bone to expose the common carotid artery. There is then a soft, flexible sheath that is tucked into the carotid artery and connected to a system that will turn the flow of blood away from the brain to protect against plaque that may come loose during the procedure. The blood is filtered and returned through a second sheath placed in the femoral vein in the patient’s thigh. Because the flow reversal method does not rely on a distally placed filter to capture emboli before they reach the brain, it collects both small and large debris. This is a less invasive endovascular technique to treat blockage in the artery caused by stroke


The Thomas Jefferson Angioplasty and Vascular Center


If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at


Doctor Q and A

Read the entire Doctor Q&A for Paul DiMuzio, MD, FACS

Read the entire Q&A