Carotid revascularization is an important method of stroke prevention and includes carotid endarterectomy and transfemoral carotid angioplasty and stenting. More recently, a hybrid open-endovascular approach, termed transcarotid artery revascularization (TCAR), is garnering increased attention. Although fundamentally a ‘stenting procedure’, unlike transfemoral carotid angioplasty and stenting, TCAR allows for a proximal neuroprotection strategy based on flow reversal. In this technical video, we will review operative techniques and nuances of the TCAR procedure, with a particular focus on the neurovascular proceduralist looking to adopt this technique into routine clinical practice(video 1).
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Contributors NS wrote the abstract and edited the videos. JA filmed parts of the video and drew illustrative figure. AK and DR filmed the video clips. BJC, AZ, and RH helped with final editing. CM directed the script and carried out the procedure.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests BJC is a non-paid consultant for Silk Road Medical. CM receives NIH support from R21NS119992 from the National Institute of Neurological Disorders and Stroke. He serves as site-PI for the following carotid revascularization trials: TCAR-DWI (Silk Road Medical) and CONFIDENCE (Microvention-Terumo). He is a non-paid consultant for Silk Road Medical.
Provenance and peer review Not commissioned; externally peer reviewed.