Tried and True: TCAR for Coronary Artery Disease

Experiencing a lack of energy, Paul Wywierowski of Harrison Township thought he might soon have another heart attack. His cardiovascular medicine specialist Natesh Lingam, M.D., sent Paul to Vascular Surgeon Sachinder Hans, M.D. for an ultrasound. Paul was diagnosed was bilateral severe carotid artery stenosis.

Dr. Hans brought in his colleague Vascular Surgeon Kaitlyn Rountree, D.O., at Henry Ford Macomb Hospital, for further testing. “A 3D CT showed both my carotid arteries were blocked and I needed stents on both sides,” explains Paul.

For some, plaque buildup in the carotid arteries may only bring mild symptoms, like Paul experienced, or may go unnoticed. For others the plaque causes arteries to harden and narrow, blocking the blood flow and restricting perfusion to the brain creating a more urgent situation such as mini stroke. Transcarotid artery revascularization (TCAR) treats carotid artery disease and provides great benefit to patients and especially for those who might be too sick or high risk for open surgical interventions.

Luckily for Paul, Dr. Rountree had recently returned to Henry Ford Macomb Hospital following a vascular fellowship in Missouri. “TCAR is a hybrid procedure that combines the less invasive benefits of placing a stent with the low stroke risk of traditional carotid surgery,” she says. “I learned the procedure during my fellowship and am happy to bring these skills and experience back to my patients at Henry Ford.”

Dr. Rountree explains, “TCAR is a minimally invasive vascular procedure that combines the benefits of using a stent with the safety of an open surgical exposure. To perform the procedure, I make a small incision on the base of the neck to expose the common carotid artery and place a puncture in the groin to access the femoral vein. This allows me to use the specialized TCAR system to place a stent across the affected artery while staying away from the diseased portion of the artery until it’s safe to manipulate it.”

Dr. Roundtree further explained, “TCAR is less invasive than other carotid artery treatment options like traditional open surgery and transfemoral stenting. TCAR usually requires a shorter hospital stay and has a faster recovery time, with less risk of injury to nerves, muscles, and lower stroke risk than transfemoral stenting. The most significant benefit is the lower risk of stroke.”

Paul recalled, “Dr. Lingam, Dr. Hans, and Dr. Rountree worked together on my case, they talked to each other and decided what was the best option for me. Dr. Rountree was patient and kind as she explained everything to me and together, we decided that TCAR was the right procedure to fix my problem.

In November, the left carotid artery was opened and in December the right, which was a little more challenging, but Dr. Rountree didn’t give up on me. There’s no doubt Dr. Rountree saved my life.”

Dr. Rountree added, “Some of our patients travel a long distance, and I want to ensure they receive top-notch care here at Henry Ford Macomb Hospital without having to travel all the way to Detroit. I’m proud to be able to offer newer procedures and technologies right here. TCAR is a great option for well-selected patients and can be life changing for them.”