St. Charles Bend is the first hospital in Oregon to offer a new treatment program for patients at risk for stroke due to blockages in their neck arteries.
The minimally invasive procedure, called TransCarotid Artery Revascularization or TCAR, utilizes a new FDA-approved neuroprotection system that temporarily reverses blood flow in the artery during the procedure. Dangerous bits of plaque and blood clots that could dislodge and otherwise travel to the brain and cause a stroke are safely diverted away while a dedicated transcarotid stent is inserted to open and stabilize the blockage.
Prior to TCAR, the main treatment option for severe carotid artery disease was an open surgical procedure called carotid endarterectomy. The surgical technique allows for protection of the brain during the procedure, but the larger incision leaves a visible scar the length of the neck and, though infrequent, can carry risks of surgical complications including bleeding, infection, heart attack and cranial nerve injuries that can cause issues with swallowing, speaking and sensation in the face.
Dr. Wayne Nelson, a vascular surgeon at Bend Memorial Clinic, is among the first in the country to gain expertise with the TCAR procedure.
“The procedure is far less invasive than carotid endarterectomy, and the procedural stroke rate appears lower than any other carotid intervention we have done previously,” he said. “This is especially true in high-risk patients where the stroke rate in the Society for Vascular Surgery database is 3.6 percent and 4.8 percent for carotid endarterectomy and traditional trans-femoral stenting respectively. In the ROADSTER IDE clinical study, the stroke rate for the new TCAR procedure, in the same high risk patient population, was only 1.4 percent overall, and if you look at patients treated per protocol, that stroke risk dropped to only 0.7 percent. “
Alice Dougan, 76, was one of the first patients to undergo the procedure at St. Charles Bend. Dugan, who underwent a carotid endarterectomy on her right artery in February, waited until TCAR became available to have surgery on her left artery. “I felt it was a good thing to wait for and I was right,” she said, noting her recovery time was faster. “This particular procedure is so much better…by the third day I felt great. I still feel great.”
The Society for Vascular Surgery (SVS) Patient Safety Organization (PSO), in collaboration with the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS), recently introduced Medicare coverage for the TCAR procedure through the TCAR Surveillance Project. The initiative provides expanded insurance coverage of TCAR procedures for Medicare beneficiaries while allowing individual hospitals and the society to track quality benchmarks.