Transcarotid

Transcarotid refers to approaches or access routes that involve the carotid arteries, particularly direct access through the common carotid artery in the neck. In vascular and neurovascular medicine, transcarotid techniques are most often discussed in the context of transcarotid carotid artery stenting (TCAR), a method designed to revascularize the internal carotid artery while minimizing cerebral embolization.

In the TCAR procedure, a surgeon makes a small neck incision to expose the common carotid artery and places a short access sheath. The system is connected to a flow reversal circuit that temporarily diverts blood away from the brain and through a filter, providing neuroprotection during stent deployment. After the stent is positioned and deployed in the internal carotid artery, normal blood flow is restored and the access site is closed. This transcarotid approach contrasts with transfemoral carotid stenting, which uses vessels in the leg for delivery.

Indications for transcarotid techniques include carotid artery stenosis where conventional carotid endarterectomy or transfemoral stenting may present higher risk or technical challenges. It is considered in symptomatic and selected asymptomatic patients, particularly when favorable anatomy or prior neck surgery limits other approaches. Outcomes reported in clinical experience emphasize neuroprotection benefits, with variable results influenced by patient factors and institutional expertise.

History and development: transcarotid strategies emerged in the 2000s–2010s, with the ENROUTE transcarotid neuroprotection system receiving regulatory clearance in the mid-2010s. Since then, TCAR has been adopted in many vascular centers as an alternative revascularization option for select patients.

See also: carotid endarterectomy, carotid artery stenting, flow reversal, ENROUTE.