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Yale New Haven Hospital first in Connecticut to perform new procedure to open blocked carotid arteries

Monday, June 13, 2016

Minimally invasive technique part of clinical trial for higher-risk surgical patients

Yale New Haven Hospital (YNHH) was the first hospital in Connecticut to perform a new, less-invasive procedure to help clear plaque-ridden carotid arteries. The procedure, performed by physicians from the Yale School of Medicine as part of a clinical trial, took place on May 31 at YNHH.

The new TCAR Procedure (TransCarotid Artery Revascularization) protects the brain from stroke risk during carotid artery stenting. It allows physicians to deliver a stent directly from the neck, which is intended to avoid complications associated with starting from the femoral artery in the groin, which is typically used in carotid artery stenting procedures.

A unique aspect of the new system is the ability to temporarily divert blood flow away from the plaque during the procedure to help ensure that a patient's brain is protected from plaque debris at all times. Physicians redirect blood flow from the carotid artery, where the team is working, into tubing set up outside the body and then back into the body through the femoral vein, near the groin.

“This is groundbreaking surgery and we are excited to bring this procedure to our patients,” said Timur Sarac, MD, section chief of Vascular Surgery at Yale New Haven Hospital and professor of Surgery at Yale School of Medicine. “TCAR has proven to be safer and less invasive for our patients, improving recovery time.” The procedure was done by a multidisciplinary group of physicians including: Vascular surgeons (Drs. Ochoa Chaar, Sarac, Orion and Dardik), Interventional Radiology (Dr. Pollack) and Cardiology (Dr. Curtis).

Current treatment options include the traditional “open” surgery approach to clean out the carotid artery and a minimally invasive alternative that uses a stent to keep the artery open.

Each of these options has some limitations. Traditional surgery involves making a large incision along the neck and carries the risk of surgical complications. While less invasive, the traditional stent procedure requires the insertion of a catheter through an artery in the groin to guide the stent into place, which can potentially dislodge plaque; loose plaque can travel through the bloodstream and cause a blockage. Some studies have indicated that the stent procedure originating in the groin carries a higher risk of stroke than the surgical procedure.

Just as arteries to the heart can become clogged with plaque, causing a blockage, so can the two carotid arteries that supply blood to the brain. Every year, more than 300,000 people in the U.S. are diagnosed with such blockages, which, if left untreated, can reduce or even stop blood flow to the brain, causing a potentially disabling stroke.

A team of Yale School of Medicine physicians also performed this procedure on the same day at the VA Connecticut.