Breakthrough Technology Helps Prevent Stroke
Dr. Amod Tendulkar discusses TransCarotid Artery Revascularization or TCAR.
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Learn more about Amod Tendulkar, MD
Amod Tendulkar, MD
Amod Tendulkar, MD, is a Cardiothoracic Surgeon with Dignity Health.Learn more about Amod Tendulkar, MD
Transcription:
Breakthrough Technology Helps Prevent Stroke
Bill Klaproth (Host): St. Joseph’s Heart and Vascular Institute has a new breakthrough technology for carotid artery disease to help prevent stroke and it’s called transcarotid artery revascularization or TCAR, and it helps treat patients with carotid artery disease who are at risk for traditional open surgery. Sounds really interesting. Let’s find out more with Dr. Amod Tendulkar, a cardiothoracic surgeon at Dignity Healthy. Dr. Tendulkar, so St. Joseph’s Heart and Vascular Institute is proud to be the first in the central valley to offer the TCAR procedure. Exactly what is it?
Dr. Amod Tendulkar (Guest): Yes, it’s a procedure that combines stenting without having to go through the groin for carotid disease, meaning there’s a blockage in the carotid artery that is considered significant that puts patients at risk for stroke. This procedure allows patients who may not be typical candidates for open procedures to have this procedure done with low operative risks.
Host: So you don’t go in through the groin, you do this more locally? Near the neck area?
Dr. Tendulkar: It’s a combination. So it’s a small incision that’s made on the carotid artery, rather than a big neck incision that’s made in a typical procedure. The incision keeps it away from a couple of important nerves that can get injured with an open procedure. It’s with a catheter based technique and it has a special procedure or an option where the flow while we’re putting the stent up is reversed so there’s no clot or any plaque going up to the brain while the stent is being deployed. It does require a small poke in the groin for that blood that’s getting essentially reversed from the carotid from the brain. It has to be put back in, so it gets put back into a vein in the groin. So it’s not a big incision in the groin and it’s not a big incision in the neck.
Host: So then this prevents the patient from stroke during the procedure?
Dr. Tendulkar: Yes, typically what happens is when we do an open procedure, the artery is clamped to allow a bloodless field and in the process of clamping, you can send up some plaques going up there. The typical stenting that’s done through the groin can create plaques that can cause stroke as well, even though they may have devices to catch those strokes while they’re putting the stent, but the reversing of the blood flow actually sucks out that plaque and prevents the stroke from happening during the procedure.
Host: Ah ha, you’re not accidentally sending plaque up into the brain, you’re screening it out. So who’s a good candidate for this procedure?
Dr. Tendulkar: Patients that are considered high risk for open carotid procedure are good candidates for this procedure. Some of the examples include patients who may be – age over 80, patients who may have lung disease, COPD that may not be good candidates for general anesthesia. This procedure, once the surgeons are comfortable, can be done with some sedation, local numbing medication. People who may have had prior neck radiation but they do have an area that we can get to the carotid artery at the base of the neck with a small incision, those are the patients who can get this procedure done. These are the good candidates for the procedure.
Host: So Dr. Tendulkar, since this is minimally invasive, is it a shorter procedure and does it allow for a shorter recovery time?
Dr. Tendulkar: It’s a shorter procedure once the skill is down. The timing is about – can be as short as 10-15 minutes for the procedure and definitely shouldn’t be more than an hour. When we do our carotid procedures, they average about an hour. Patients end up getting a relatively decent sized neck incision that can make some sore spots in the neck from surgery. This is a much smaller incision, so from that perspective recovery is shorter. I think the hospital stay is not very different. So the hospital stay ends up being an overnight stay whether the stent is done through the groin or whether the stent is done with a TCAR procedure or an open procedure.
Host: So this stent then, this protects people from future strokes. You’re inserting the stent in that carotid artery?
Dr. Tendulkar: So the stent opens up the blockage and the plaques that were the – that can come off and go to the brain and cause a stroke get sort of squished by the stent, so that’s how it prevents future strokes.
Host: So is the carotid artery more prone to plaque build up?
Dr. Tendulkar: Most of the arteries are prone to plaque but it is an important artery because it supplies obviously the brain so it is important to monitor that and follow that. So patients with diabetes, high blood pressure, smoking, are all at risk for carotid artery disease. Patients who have heart diseases, automatically also can have carotid disease. Patients may have peripheral vascular disease and have carotid disease as well.
Host: Great information, thank you Dr. Tendulkar, and to learn more about the TCAR procedure, and to get hooked up with one of our providers, please visit stjosephscares.org/heart, that’s stjosephscares.org/heart, and if you like what you’ve heard, please share this on your social channels and be sure to check out our entire podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth, thanks for listening.
Breakthrough Technology Helps Prevent Stroke
Bill Klaproth (Host): St. Joseph’s Heart and Vascular Institute has a new breakthrough technology for carotid artery disease to help prevent stroke and it’s called transcarotid artery revascularization or TCAR, and it helps treat patients with carotid artery disease who are at risk for traditional open surgery. Sounds really interesting. Let’s find out more with Dr. Amod Tendulkar, a cardiothoracic surgeon at Dignity Healthy. Dr. Tendulkar, so St. Joseph’s Heart and Vascular Institute is proud to be the first in the central valley to offer the TCAR procedure. Exactly what is it?
Dr. Amod Tendulkar (Guest): Yes, it’s a procedure that combines stenting without having to go through the groin for carotid disease, meaning there’s a blockage in the carotid artery that is considered significant that puts patients at risk for stroke. This procedure allows patients who may not be typical candidates for open procedures to have this procedure done with low operative risks.
Host: So you don’t go in through the groin, you do this more locally? Near the neck area?
Dr. Tendulkar: It’s a combination. So it’s a small incision that’s made on the carotid artery, rather than a big neck incision that’s made in a typical procedure. The incision keeps it away from a couple of important nerves that can get injured with an open procedure. It’s with a catheter based technique and it has a special procedure or an option where the flow while we’re putting the stent up is reversed so there’s no clot or any plaque going up to the brain while the stent is being deployed. It does require a small poke in the groin for that blood that’s getting essentially reversed from the carotid from the brain. It has to be put back in, so it gets put back into a vein in the groin. So it’s not a big incision in the groin and it’s not a big incision in the neck.
Host: So then this prevents the patient from stroke during the procedure?
Dr. Tendulkar: Yes, typically what happens is when we do an open procedure, the artery is clamped to allow a bloodless field and in the process of clamping, you can send up some plaques going up there. The typical stenting that’s done through the groin can create plaques that can cause stroke as well, even though they may have devices to catch those strokes while they’re putting the stent, but the reversing of the blood flow actually sucks out that plaque and prevents the stroke from happening during the procedure.
Host: Ah ha, you’re not accidentally sending plaque up into the brain, you’re screening it out. So who’s a good candidate for this procedure?
Dr. Tendulkar: Patients that are considered high risk for open carotid procedure are good candidates for this procedure. Some of the examples include patients who may be – age over 80, patients who may have lung disease, COPD that may not be good candidates for general anesthesia. This procedure, once the surgeons are comfortable, can be done with some sedation, local numbing medication. People who may have had prior neck radiation but they do have an area that we can get to the carotid artery at the base of the neck with a small incision, those are the patients who can get this procedure done. These are the good candidates for the procedure.
Host: So Dr. Tendulkar, since this is minimally invasive, is it a shorter procedure and does it allow for a shorter recovery time?
Dr. Tendulkar: It’s a shorter procedure once the skill is down. The timing is about – can be as short as 10-15 minutes for the procedure and definitely shouldn’t be more than an hour. When we do our carotid procedures, they average about an hour. Patients end up getting a relatively decent sized neck incision that can make some sore spots in the neck from surgery. This is a much smaller incision, so from that perspective recovery is shorter. I think the hospital stay is not very different. So the hospital stay ends up being an overnight stay whether the stent is done through the groin or whether the stent is done with a TCAR procedure or an open procedure.
Host: So this stent then, this protects people from future strokes. You’re inserting the stent in that carotid artery?
Dr. Tendulkar: So the stent opens up the blockage and the plaques that were the – that can come off and go to the brain and cause a stroke get sort of squished by the stent, so that’s how it prevents future strokes.
Host: So is the carotid artery more prone to plaque build up?
Dr. Tendulkar: Most of the arteries are prone to plaque but it is an important artery because it supplies obviously the brain so it is important to monitor that and follow that. So patients with diabetes, high blood pressure, smoking, are all at risk for carotid artery disease. Patients who have heart diseases, automatically also can have carotid disease. Patients may have peripheral vascular disease and have carotid disease as well.
Host: Great information, thank you Dr. Tendulkar, and to learn more about the TCAR procedure, and to get hooked up with one of our providers, please visit stjosephscares.org/heart, that’s stjosephscares.org/heart, and if you like what you’ve heard, please share this on your social channels and be sure to check out our entire podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth, thanks for listening.