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TCAR: Newer Approach to Carotid Artery Stenosis
Dr. Bradley Grimsley, a Vascular Surgeon, walks us through the Transcarotid Artery Revascularization (TCAR) procedure.
Featured Speaker:
Bradley Grimsley, MD, FACC
Bradley Grimsley, MD, FACS is a Vascular Surgeon on the medical staff at Baylor Scott & White Heart and Vascular Hospital - Dallas. Transcription:
TCAR: Newer Approach to Carotid Artery Stenosis
Caitlin Whyte (Host): Welcome back to Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital. I'm your host, Caitlin Whyte. Today, we welcome Dr. Bradley Grimsley to the show. He is a Vascular Surgeon and Fellow of the American College of Surgeons speaking on behalf of the Vascular Surgery Program at Baylor Scott and White Heart and Vascular Hospital, Dallas. Dr. Grimsley is a nationally recognized pioneer in the use of a breakthrough technology called trans carotid artery revascularization, or TCAR to treat patients with carotid artery disease, who are at risk for open surgery. He will be telling us all about this new technology today. So, Dr. Grimsley, what would a patient's diagnosis be that would lead to having this TCAR procedure?
Bradley Grimsley, MD, FACC (Guest): A carotid artery stenosis.
Host: And how has TCAR replaced the traditional open surgery?
Dr. Grimsley: For many years, we had two basic options of carotid endarterectomy, and transfemoral carotid artery stenting. What TCAR does is takes the best part of open carotid endarterectomy and uses surgical principles and makes the stenting of the carotid artery safer by using a reversal of flow system.
Host: So, doctor, how will this change patient's post-surgery care and recovery?
Dr. Grimsley: The patients that typically get TCAR will go home on post-op day one, typically, and have a much smaller incision from where the procedure has taken place and recover much quicker because of the shorter operative times and the smaller incision.
Host: Now why is TCAR such breakthrough technology?
Dr. Grimsley: It is such a breakthrough because for so many years, people like transfemoral carotid stenting, because the patients typically do well and have good long-term results. However, the stroke risk was unacceptable. So, something had to be done to decrease the stroke risks related to transfemoral carotid stenting. So, TCAR was developed, and a flow reversal system was developed, associated with it where the neuroprotection that one receives from TCAR is basically reversing flow in the carotid artery, instead of putting a filter in place, as we did with transfemoral carotid, stenting. So, you have two stenting procedures.
The carotid stent is the same, but the neuroprotection is different. With transfemoral carotid stenting, just to review, we had to cross the lesion and put basically a basket or embolic protection device above the lesion when the carotid stent was deployed. With TCAR, we are reversing flow, reversing flow in the carotid artery. When we place the stent, the flow is reversed and all of the debris is then flushed out through a filter outside of the body.
Host: Who would be a good candidate for this procedure?
Dr. Grimsley: Okay. So, as it stands now, higher risk patients that have surgically inaccessible lesions, older patients say greater than 75, patients that have severe coronary disease and cannot undergo a general anesthetic and need it done under local anesthesia. TCAR can be done under local, in fact, most people do it, a lot of people do it under local anesthesia, which decreases the anesthetic risk. People with compromised lungs, compromised kidneys, out of control diabetes, people you really don't want to put a big incision on their neck and maybe place a piece of prosthetic material in their neck, which is required with a carotid endarterectomy.
So, all of those, radiation to the neck. Sometimes those patients are really good candidates for TCAR. Those are the most common and well actually I left one out, previous carotid endarterectomy. Patients who have previous carotid endarterectomy who have recurrent stenosis. You don't want to go back into a scarred in field to fix this. So, therefore, TCAR is ideal for this. Those are probably the most common.
Host: And if people want to learn more, where can they start the research?
Dr. Grimsley: Oh, yeah. I mean the Silk Road Medical and TCAR is all over the internet. They are YouTube videos. You can also look up Silk Road Medical, and the TCAR procedure, and they have videos to review that online. So, it's a plethora of information online.
Host: Wonderful. Dr. Grimsley, is there anything else that you'd like to add to this conversation about TCAR?
Dr. Grimsley: As someone who does, I've done over a thousand carotid endarterectomies and done 300 to 400 transfemoral carotid stents over the years, TCAR, which started, I started doing it in late 2016. It's one of those procedures that has really, is a game changer, I think it was fair to say. And I think, carotid endarterectomy is one of those procedures that we do as surgeons that is very, has good outcomes and its fun to do. So, the fact that a procedure like TCAR could come along and really change the way surgeons do things in a procedure that they love to do, and we already have a good out with another procedure like carotid endarterectomy, it has to be quite impressive. TCAR has absolutely been that procedure. From patient satisfaction standpoint to a, for the endovascular minded surgeon, it really uses the endovascular techniques, but also has surgical techniques associated with it as well.
So, from a physician standpoint who performs the procedure, it's very satisfying. And also from a patient standpoint, they love it because it's a quick procedure in and out and a small incision and they get the equivalent results to a carotid endarterectomy for years.
Host: Sounds like a win-win all around.
Dr. Grimsley: Yeah, it is. It's really great procedure.
Host: Well doctor, thank you so much for your time and for this expertise today. That's Dr. Bradley Grimsley, a Vascular Surgeon on the medical staff at Baylor Scott and White Heart and Vascular Hospital, Dallas. And thank you for checking out this episode of Heart Speak. To find a specialist on our medical staff please call 1-844-279-3627. That's 1-844-279-3627. Or visit Baylorhearthospital.com. And if you found this podcast helpful, please share it on all your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk again soon.
Baylor Scott and White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.
TCAR: Newer Approach to Carotid Artery Stenosis
Caitlin Whyte (Host): Welcome back to Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital. I'm your host, Caitlin Whyte. Today, we welcome Dr. Bradley Grimsley to the show. He is a Vascular Surgeon and Fellow of the American College of Surgeons speaking on behalf of the Vascular Surgery Program at Baylor Scott and White Heart and Vascular Hospital, Dallas. Dr. Grimsley is a nationally recognized pioneer in the use of a breakthrough technology called trans carotid artery revascularization, or TCAR to treat patients with carotid artery disease, who are at risk for open surgery. He will be telling us all about this new technology today. So, Dr. Grimsley, what would a patient's diagnosis be that would lead to having this TCAR procedure?
Bradley Grimsley, MD, FACC (Guest): A carotid artery stenosis.
Host: And how has TCAR replaced the traditional open surgery?
Dr. Grimsley: For many years, we had two basic options of carotid endarterectomy, and transfemoral carotid artery stenting. What TCAR does is takes the best part of open carotid endarterectomy and uses surgical principles and makes the stenting of the carotid artery safer by using a reversal of flow system.
Host: So, doctor, how will this change patient's post-surgery care and recovery?
Dr. Grimsley: The patients that typically get TCAR will go home on post-op day one, typically, and have a much smaller incision from where the procedure has taken place and recover much quicker because of the shorter operative times and the smaller incision.
Host: Now why is TCAR such breakthrough technology?
Dr. Grimsley: It is such a breakthrough because for so many years, people like transfemoral carotid stenting, because the patients typically do well and have good long-term results. However, the stroke risk was unacceptable. So, something had to be done to decrease the stroke risks related to transfemoral carotid stenting. So, TCAR was developed, and a flow reversal system was developed, associated with it where the neuroprotection that one receives from TCAR is basically reversing flow in the carotid artery, instead of putting a filter in place, as we did with transfemoral carotid, stenting. So, you have two stenting procedures.
The carotid stent is the same, but the neuroprotection is different. With transfemoral carotid stenting, just to review, we had to cross the lesion and put basically a basket or embolic protection device above the lesion when the carotid stent was deployed. With TCAR, we are reversing flow, reversing flow in the carotid artery. When we place the stent, the flow is reversed and all of the debris is then flushed out through a filter outside of the body.
Host: Who would be a good candidate for this procedure?
Dr. Grimsley: Okay. So, as it stands now, higher risk patients that have surgically inaccessible lesions, older patients say greater than 75, patients that have severe coronary disease and cannot undergo a general anesthetic and need it done under local anesthesia. TCAR can be done under local, in fact, most people do it, a lot of people do it under local anesthesia, which decreases the anesthetic risk. People with compromised lungs, compromised kidneys, out of control diabetes, people you really don't want to put a big incision on their neck and maybe place a piece of prosthetic material in their neck, which is required with a carotid endarterectomy.
So, all of those, radiation to the neck. Sometimes those patients are really good candidates for TCAR. Those are the most common and well actually I left one out, previous carotid endarterectomy. Patients who have previous carotid endarterectomy who have recurrent stenosis. You don't want to go back into a scarred in field to fix this. So, therefore, TCAR is ideal for this. Those are probably the most common.
Host: And if people want to learn more, where can they start the research?
Dr. Grimsley: Oh, yeah. I mean the Silk Road Medical and TCAR is all over the internet. They are YouTube videos. You can also look up Silk Road Medical, and the TCAR procedure, and they have videos to review that online. So, it's a plethora of information online.
Host: Wonderful. Dr. Grimsley, is there anything else that you'd like to add to this conversation about TCAR?
Dr. Grimsley: As someone who does, I've done over a thousand carotid endarterectomies and done 300 to 400 transfemoral carotid stents over the years, TCAR, which started, I started doing it in late 2016. It's one of those procedures that has really, is a game changer, I think it was fair to say. And I think, carotid endarterectomy is one of those procedures that we do as surgeons that is very, has good outcomes and its fun to do. So, the fact that a procedure like TCAR could come along and really change the way surgeons do things in a procedure that they love to do, and we already have a good out with another procedure like carotid endarterectomy, it has to be quite impressive. TCAR has absolutely been that procedure. From patient satisfaction standpoint to a, for the endovascular minded surgeon, it really uses the endovascular techniques, but also has surgical techniques associated with it as well.
So, from a physician standpoint who performs the procedure, it's very satisfying. And also from a patient standpoint, they love it because it's a quick procedure in and out and a small incision and they get the equivalent results to a carotid endarterectomy for years.
Host: Sounds like a win-win all around.
Dr. Grimsley: Yeah, it is. It's really great procedure.
Host: Well doctor, thank you so much for your time and for this expertise today. That's Dr. Bradley Grimsley, a Vascular Surgeon on the medical staff at Baylor Scott and White Heart and Vascular Hospital, Dallas. And thank you for checking out this episode of Heart Speak. To find a specialist on our medical staff please call 1-844-279-3627. That's 1-844-279-3627. Or visit Baylorhearthospital.com. And if you found this podcast helpful, please share it on all your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk again soon.
Baylor Scott and White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.