Hill Country Memorial is the first medical facility in the hill country to begin performing a new procedure to address narrowing and blockages of the carotid artery.

Traditionally, the two ways of cleaning plaque from the artery feeding blood to the brain are carotid endarterectomy, where the surgeon opens the artery and removes the plaque; and carotid artery stenting (CAS), where a stent is inserted from the groin artery over a wire to open the blocked artery and trap the plaque so that the plaque cannot embolize (break off and go to the brain) which is one of the most common causes of stroke.

Both of these procedures are still utilized, but now Andrew N. Bowser, MD, FACS, Vascular Surgery, has begun offering TCAR, which stands for TransCarotid Arterial Revascularization. Simply described, TCAR temporarily reverses blood flow from the brain by shunting the blood to the femoral vein during the stenting procedure and filters any debris that otherwise could go to the brain during traditional carotid stenting. The stent is then inserted for long-term stabilization.

For patients that are good candidates for the new procedure, the advantages include a smaller incision, shorter time under anesthesia, and less blood loss.

“It is a good procedure that has equivalent outcomes to the other procedures we do,” said Bowser. “It is a great adjunct to what we already do here at HCM.”

According to his estimates, 30 to 40% of patients will meet the medical criteria as well as the Medicare requirements to qualify for reimbursement.

Bowser and his team began performing TCAR procedures in November, all with positive results.

“The patients have done well, with much less pain due to the small incision,” he said. “Procedures are currently performed under general anesthesia, but in the future will move to local anesthesia or a nerve block.”

One challenge with diagnosing stenosis or narrowing of the carotid artery is that 80% of individuals experiencing it are asymptomatic. Risk factors for developing this are those with high cholesterol, hypertension, diabetes, a significant smoking history, family history or those typically older than 65.

For some patients, carotid stenosis may manifest with stroke or transient ischemic attacks (TIA). These symptoms follow the FAST acronym:

-Face drooping, especially if uneven or one-sided
-Arm or leg weakness on one side of the body
-Speech slurring, garbled words, inability to repeat a simple sentence
-Time to call 911 if an individual exhibits any of these symptoms

The more quickly a patient arrives at the hospital, the better their chances of survival and recovery.

“TCAR is an exciting, newly-approved procedure,” Bowser said. “While our other means of dealing with carotid artery stenoses will not go away, TCAR is another reason for patients to stay here in the Hill Country for treatment for this disease process. We are fortunate to be the first to have it available in this area.”

For more information about the procedure contact Dr. Bowser’s office at 830-990-1404 or by visiting www.hillcountrymemorial.org.