Transcarotid artery revascularization is a stent-based procedure used to treat carotid artery narrowing and help reduce the risk of stroke. A key feature of TCAR is temporary blood flow reversal, which helps protect the brain from plaque debris during treatment. Tampa General Hospital offers TCAR and a full range of vascular surgery services to patients throughout Brooksville, Spring Hill, Crystal River and surrounding communities. Procedures are performed at TGH Brooksville, with specialist evaluations, individualized planning and carotid stent surveillance available throughout the region.
What Is Transcarotid Artery Revascularization?
TCAR is a carotid artery stenting procedure designed to restore blood flow through a narrowed carotid artery while helping protect the brain during treatment. The carotid arteries are major blood vessels on either side of the neck that supply blood and nutrients to the brain.
During the TCAR procedure, the vascular surgeon will make a small incision near the base of the neck, just above the collarbone, to access the affected carotid artery. A temporary blood flow reversal system will be used while the surgeon places a stent inside the narrowed portion of the artery. The stent will then expand against the artery wall, helping to hold the vessel open and improve blood flow.
Unlike carotid stenting, which is performed through an artery in the groin or wrist, the transcarotid approach provides more direct access to the carotid artery. The combination of direct carotid access, stent placement and temporary blood flow reversal distinguishes TCAR from other carotid revascularization procedures.
What Conditions Can Be Treated With Transcarotid Artery Revascularization?
TCAR is primarily used to treat carotid artery stenosis, a condition in which plaque buildup narrows one or both carotid arteries. The plaque can restrict blood flow to the brain and increase the risk of transient ischemic attack (TIA) and stroke.
Carotid artery revascularization may be considered for a patient with significant carotid narrowing, especially if they have already experienced symptoms, such as TIA or stroke, or if they have high-grade carotid stenosis without symptoms. Whether TCAR is appropriate depends on the degree and location of the narrowing and the patient’s symptoms, anatomy, overall health and other clinical factors.
How Can Transcarotid Artery Revascularization Help Prevent Stroke?
Carotid artery stenosis increases the risk of stroke because plaque can narrow the artery and interfere with healthy blood flow. Pieces of plaque or blood clots can also break away from the affected area, travel to the brain and block smaller blood vessels.
TCAR addresses stroke risk by placing a stent in the narrowed artery to improve blood flow and stabilize plaque against the arterial wall. During the stent placement, the vascular surgery team will use a temporary flow reversal system for neuroprotection. Instead of allowing blood and potential plaque debris to travel toward the brain, blood flow in the treated carotid artery will be temporarily redirected away from the brain and into a filtration system. The filtered blood will then be returned to circulation through a vein.
Once the stent is securely positioned, normal blood flow toward the brain will be restored. This flow reversal technology is an important feature of TCAR and is specifically designed to reduce the chance that plaque debris will reach the brain during the procedure.
Who Is a Candidate for Transcarotid Artery Revascularization?
Not everyone with carotid artery stenosis requires surgery or is a candidate for TCAR. Treatment recommendations can vary based on several factors, including the severity of the arterial narrowing, the location of the plaque and the patient’s symptoms, anatomy and overall health.
TCAR may be considered for an appropriately selected patient who could benefit from carotid revascularization, particularly if they have clinical or anatomical factors that increase the risks associated with traditional open carotid surgery. These factors may include prior neck surgery or radiation therapy, certain structural characteristics of the neck or carotid arteries or another significant medical condition, such as heart or lung disease.
At TGH, each patient undergoes a thorough evaluation to determine whether TCAR, carotid endarterectomy, another form of carotid artery stenting or medical management is the most appropriate option.
How Does Transcarotid Artery Revascularization Differ From Carotid Endarterectomy?
Both TCAR and carotid endarterectomy are carotid revascularization procedures intended to treat significant carotid artery narrowing and reduce stroke risk, but they do so in different ways. Carotid endarterectomy is an open surgical procedure in which the vascular surgeon will make an incision in the neck, open the carotid artery and directly remove plaque from inside the vessel.
Alternatively, TCAR is a minimally invasive procedure in which the vascular surgeon will make a small incision near the base of the neck and place a stent inside the carotid artery to hold the narrowed area open. During stent placement, temporary blood flow reversal will help direct potential plaque debris away from the brain.
Neither procedure is universally better for every patient. Instead, the most appropriate approach will depend on factors such as the location and severity of the stenosis and the patient’s anatomy, previous neck procedures and overall surgical risk. The vascular surgery services team at TGH will carefully consider these and other factors when recommending a treatment strategy.
What Is Recovery Like After Transcarotid Artery Revascularization?
Recovery after TCAR is generally shorter than recovery from traditional open carotid surgery, mainly because it uses a smaller incision and does not require extensive surgical exposure of the carotid artery. The patient will be monitored closely after the procedure, including assessments of neurological function, blood pressure and the treatment site.
The length of the hospital stay and overall TCAR recovery time can vary depending on the patient’s health and response to treatment. Before leaving the hospital, the patient will receive individualized instructions regarding medication use, incision care, activity restrictions and returning to normal activities.
After the placement of the carotid stent, medications that help prevent blood clots will be an important part of treatment. The patient should take all prescribed medications exactly as directed and attend scheduled follow-up visits.
What Are the Risks of Transcarotid Artery Revascularization?
Although TCAR incorporates temporary blood flow reversal specifically to help protect the brain while the carotid stent is being placed, no carotid artery procedure can eliminate stroke risk completely. Other risks and possible complications include TIA, stroke, bleeding, infection, blood vessel injury, reactions to medications or contrast material and problems involving the carotid stent. Over time, the treated artery may also narrow again, a condition known as restenosis.
Before recommending TCAR, the vascular surgery team will weigh the potential benefits and risks based on the patient’s carotid disease, anatomy, medical history and overall health. The patient will receive a detailed explanation of what to expect so they can make a fully informed treatment decision.
Why Is Long-Term Follow-Up Imaging Important After Transcarotid Artery Revascularization?
Treatment does not end when the TCAR procedure is complete. Ongoing monitoring will help the vascular surgery team continually evaluate blood flow through the carotid artery and make sure the stent remains open and functioning properly.
Postoperative follow-up will typically include carotid duplex ultrasound, a noninvasive imaging test that uses sound waves to assess blood flow and detect narrowing within or around the stent. The timing and frequency of testing will be tailored to the patient.
Long-term management may also include medications and strategies to help reduce or control cardiovascular risk factors, such as high blood pressure, high cholesterol, diabetes and tobacco use. These measures can help protect vascular health and reduce future stroke risk.
Consult With Our Vascular Surgery Services Team
If you have been diagnosed with carotid artery stenosis, you may be at increased risk for stroke, but several treatment options may be available depending on the severity of your condition and other factors. Tampa General Hospital’s vascular surgery services team can evaluate your diagnosis, explain the differences between TCAR and other treatment options and determine the most appropriate approach for you.
TCAR procedures are performed at TGH Brooksville, with specialist evaluations and ongoing follow-up available to patients throughout Brooksville, Spring Hill, Crystal River and surrounding communities. Patients benefit from our ranking of No. 1 in the Tampa Bay region for Cardiology, Heart & Vascular Surgery by U.S. News & World Report for 2026-27. Contact Tampa General Hospital to schedule a consultation or learn more about transcarotid artery revascularization.