If you have carotid artery blockage, you may benefit from a transcarotid artery revascularization (TCAR) procedure. TCAR is a procedure performed to prevent you from having a stroke in the future. It is a minimally invasive procedure that requires a small incision at the root of the neck. TCAR is a good alternative to carotid endarterectomy, which is an open surgery that requires longer incision in the neck. TCAR has other benefits namely short surgery time, shorter hospital stays and fewer complications compared to carotid endarterectomy.

Preparing For TCAR

To determine if you are an appropriate candidate for the TCAR, your provider will have you undergo blood work, an ultrasound of your carotid artery and a CT scan of your neck.

You will also need to let your provider know about your current allergies and medications. Before the TCAR procedure, your provider may have you change your medication and may prescribe an antiplatelet drug (such as Plavix®) and aspirin. Starting at midnight before surgery, you will be asked not to drink or eat anything.

How Does TCAR Work?

Your surgeon will conduct the TCAR procedure in the operating room using local anesthesia (numbing) or general anesthesia (causing unconsciousness). The procedure is performed through a tiny incision right above your collarbone.

Under X-ray visualization, the carotid artery is punctured and a small tube is placed into the artery. Another small tube is placed in the groin through skin puncture.

The two tubes will then be connected via a different tubing which will divert the blood flow away from the brain temporarily. This system of backward flow will prevent any plaque fragment that breaks up during the procedure from traveling into the brain thus preventing the possibility of stroke. Once this system is connected, your provider will stretch the narrowed artery and place the stent to keep it from narrowing back.

Once the procedure is completed, the provider will reestablish blood flow back to the brain again.

After TCAR

The TCAR procedure is very effective and has a short recovery time. An overnight stay at the hospital is usually sufficient after the procedure.

After the TCAR procedure, be sure to follow all directions from your provider regarding your medications, diet and exercise. For a week or more, you may need to not lift a certain amount of weight. Your provider will clear you to return to normal activities when appropriate.

You will be prescribed medication to keep you from developing blood clots in the carotid artery. Later, you will undergo another ultrasound to ensure that the stent is open.

You are encouraged to lead a healthy lifestyle, exercise regularly, eat healthy foods and not smoke. Healthy choices will decrease the risk of the carotid artery becoming blocked again.


The TCAR procedure is safe, but there are still a few unlikely risks, including:

  • Swelling, bruising or bleeding at the surgical site
  • Injury to the cranial nerve
  • Heart attack
  • Stroke during or immediately after surgery
  • Death

UofL Health Can Help

UofL Physicians – Vascular Surgery and UofL Physicians – Vascular Surgery Associates have the top surgeons in the region providing comprehensive, state-of-the-art care for vascular emergencies. See our list of locations to find one near you.

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Article by: Abindra Sigdel, M.B.B.S.

Abindra Sigdel, M.B.B.S, is a vascular surgeon practicing at various UofL Health locations. His areas of interest include aortic aneurysms, endovascular and vascular options of peripheral artery disease, venous disease and hemodialysis access. Dr. Sigdel earned his M.B.B.S. at BP Koirala Institute of Health Sciences in Nepal. He completed an internship in general surgery at North Shore Long Island Jewish Hospital in New Hyde Park, New York. Dr. Sigdel completed general surgery residencies at Institute of Medicine in Nepal and UofL Health – UofL Hospital, and completed a fellowship in vascular surgery at Houston Methodist Debakey Heart & Vascular Center in Texas. He is an associate professor in the Department of Surgery at University of Louisville School of Medicine.

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