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Sharp Health News

New technique for carotid artery surgery

June 12, 2017

New technique for carotid artery surgery

Dr. Scott Musicant performs transcarotid artery revascularization (TCAR) surgery on a patient with the help of a circuit system that reverses blood flow and filters debris to prevent stroke during the procedure.

At 81 years old, Charlotte Rawlings has had multiple surgeries to treat clogged arteries in her neck.

Her doctor diagnosed her with carotid artery disease during a routine physical exam in 2004 while living in Oregon. To prevent a future stroke, she underwent open surgery to remove plaque in the artery. Surgeons opened her carotid arteries and restored blood flow through an incision in the neck.

Unfortunately, the treatment only lasted a few years. Ms. Rawlings began to experience symptoms, such as forgetfulness and low blood pressure. Doctors noticed re-narrowing in the artery. Experts placed a stent into the carotid artery that had previously been treated, this time using a blood vessel from her groin to her neck. One of the surgeons training at that hospital was Dr. Scott Musicant, a vascular surgery resident at the time.

Third time’s the charm
Fast forward more than a decade later: Ms. Rawlings is living in San Diego and her stent stopped working effectively. This time, her primary care doctor referred her to Dr. Vincent Guzzetta and, coincidentally, Dr. Musicant, both vascular surgeons affiliated with Sharp Grossmont Hospital.

Dr. Musicant performed an innovative stent procedure called transcarotid artery revascularization, or TCAR. Sharp Grossmont is the first hospital in San Diego County to offer TCAR, and last April Ms. Rawlings became the first patient to receive it.

Traditional surgeries, like those Ms. Rawlings previously underwent, carry risks and complications, such as plaque breaking free during surgery and traveling to the brain, potentially causing a stroke during the procedure. TCAR reduces this risk through a novel FDA-approved system that temporarily reverses blood flow in the arteries that deliver blood to the brain.

“With TCAR, surgeons now have a less invasive option for patients at risk for traditional surgery,” says Dr. Musicant. “The potential for procedural or long-term stroke is very low and we can avoid some of the complications of open surgery, such as nerve damage, infection and procedural heart attack. And unlike open surgery, there is less of a scar left behind, because the incision is smaller.”

How does TCAR work?
The surgeon makes a small incision just above the collarbone and places a catheter directly into the carotid artery. The catheter is connected to a small circuit outside the body that temporarily directs blood flow away from the brain.

Throughout the procedure, any debris that may break loose is captured in a filter built into the circuit. The filtered blood is then returned to the body through another catheter in the upper thigh. As the blood is being redirected and filtered, the surgeon inserts a stent in the carotid artery to stabilize plaque, decreasing the potential for future stroke. After the stent is placed, flow reversal is turned off and blood flow resumes in its normal direction.

“TCAR is so much kinder for the patient because you recover faster and aren’t in too much agony afterward,” says Ms. Rawlings. “It added years to my life, too. Without it, who knows how my story would have turned out.”

For the news media: To talk with Dr. Musicant about transcarotid artery revascularization for an upcoming story, contact Erica Carlson, senior public relations specialist, at

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