Disease and Treatment Options

Every year, 15 million people worldwide suffer a stroke. Nearly six million die and another five million are left permanently disabled. Stroke is the second leading cause of disability globally.

Ischemic strokes account for approximately 87% of all strokes in the U.S. If left untreated, these blockages can fragment, flow to the brain, and lead to a potentially disabling stroke, also known as a “brain attack.” If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen and brain cells can die, causing permanent damage.

Understand the Treatment Options

Treatment options for carotid artery disease depend upon the severity of the overall patient condition and symptoms. Moderate disease may not require a procedure. More severe blockages may require treatment with open surgery, called carotid endarterectomy (CEA), or an endovascular procedure, called Carotid Artery Stenting (CAS) in which a stent is placed to stabilize the plaque to prevent a future stroke.

Open Surgery

The most common treatment for severe carotid artery disease is a surgery called Carotid Endarterectomy (CEA). Your surgeon will make an incision on your neck to access the affected artery, open the artery and remove the plaque. Your surgeon will then close the artery and the incision in your neck using stitches.

Transfemoral Carotid Angioplasty and Stenting

For patients at high risk for the open surgical procedure, another option is transfemoral carotid angioplasty and stenting (TF-CAS). This minimally invasive alternative allows your physician to complete the procedure through a tube placed into the artery in your thigh.DTO_body02-FPO

First, a small umbrella-like filter is placed beyond the diseased area of the carotid artery to help limit fragments of plaque from traveling towards your brain throughout the procedure. Then, a small balloon is advanced to the narrowed part of your artery. Your surgeon will inflate the balloon, compressing the plaque, and then place a small mesh-like tube called a stent to cover the plaque and keep the artery open. Stabilizing the plaque with the stent is designed to reduce the potential for a stroke after the procedure.

The TCAR Procedure: TransCarotid Artery Revascularization

A potential complication of both surgery and stenting is a stroke during the procedure itself. Studies have shown a higher risk of stroke during stenting as compared to surgery. For patients at higher risk for the open surgical procedure, the TCAR Procedure, using the ENROUTE® Transcarotid Neuroprotection System, is designed to reduce the risk of stroke while inserting the ENROUTE® Transcarotid Stent.DTO_body03-FPO

The TCAR procedure is performed through a small incision at your neckline just above your clavicle. This incision is much smaller than a typical CEA incision. Your surgeon will place a tube directly into your carotid artery and connect it to a system that will direct blood flow away from your brain, to protect against plaque that may come loose reaching your brain. Your blood will flow through the system and any material will be captured in a filter outside the body. Your filtered blood will then be returned through a second tube in your upper leg. After the stent is placed successfully, flow reversal is turned off and blood flow resumes in its normal direction.

To learn more about carotid artery disease, the TCAR Procedure and the associated risks and benefits, please refer to the ENROUTE Transcarotid Stent and Neuroprotection System patient guidebook.

For additional information, please visit these external links:
The following websites are not operated by Silk Road Medical and by clicking on them, you will leave the Silk Road Medical website. :

American Stroke Association*
National Heart, Lung and Blood Association*
VascularWeb – Society for Vascular Surgery*
*Silk Road Medical does not control the content of this website