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Procedure lowers stroke, heart attack risk for some at Arizona hospitals

PHOENIX — A procedure being used in some Arizona hospitals can lower the risk of stroke or heart attack for patients with carotid artery disease.

Transcarotid Artery Revascularization, or TCAR, uses a small incision in the neck and a thin wire to treat blockages and get patients on the road to recovery quickly.

“(TCAR) avoids the arch of the aorta, which can be very tortuous,” Dr. Venkatesh Ramaiah, a vascular surgeon at Abrazo Arizona Heart Hospital, said.

The old way of treating blockages in patients — going through the groin and crossing an artery with a wire — was dangerous in the best of circumstances.

During the procedure, a small incision is made near the collarbone to expose the common carotid artery – the major neck blood vessel that supplies blood to the neck, brain and face.

A flexible sheath is placed directly into the artery, and the flow of blood is reversed away from the brain. This protects the patient from fragments of plaque that could come loose during the procedure.

The patient’s blood is filtered and returned through a second sheath placed in the femoral vein in the thigh. This allows doctors to clear veins and put in stents.

After a stent is placed to stabilize the plaque in the carotid artery, blood is allowed to flow back to the brain in a normal direction.

Ramaiah said on average, the procedure takes seven minutes. He’s performed between 40 and 45 cases, all of which were high-risk.

“There may be a lot of scar tissue in the neck, could have a tracheotomy, cancer of the neck or the blockage could be very high and you can’t get to it with the open surgery,” he said.

The results of the new procedure have been so promising that the Food and Drug Administration, along with the Centers for Medicare and Medicaid Services, have set up a special program to allow Medicaid recipients to get the treatment.

Ramaiah said if the numbers continue to be promising, the surgery could become a common option for low-risk patients. In his opinion, he said, it will be.

“We’ve had great feedback with this,” he said.

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