Transcarotid Artery Revascularization Results in Low Rates of Periprocedural Neurologic Events, Myocardial Infarction, and Death

  • Angelica R. Lackey
  • Young Erben
  • Joao Antonio Da Rocha Franco
  • James F. Meschia
  • Brajesh K. LalEmail author
Stroke (JF Meschia, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stroke


Purpose of Review

Transcarotid artery revascularization (TCAR) is a novel hybrid procedure that reverses carotid flow and places a stent using surgical access of the carotid artery in the neck under local anesthesia. We discuss the indications for carotid revascularization, the clinical rationale for TCAR, and evidence for its potential role in the management of carotid stenosis.

Recent Findings

Results from pre-clinical studies, prospective single-arm studies, and comparative analyses of registry data indicate that TCAR results in low amounts of periprocedural microembolization, cerebral lesions detectable on magnetic resonance imaging, and neurologic events, myocardial infarctions (MIs), and death.


Non-randomized comparisons suggest that TCAR may offer a novel solution to reducing periprocedural stroke, death, and MI in patients with carotid stenosis. A state of equipoise appears to have been reached with TCAR versus the traditional carotid revascularization procedures and a well-controlled randomized trial with careful oversight should be prioritized to obtain level 1 evidence.


Carotid artery Transcarotid Revascularization Flow reversal 


Funding Information

CREST-2 is funded by the National Institute of Neurological Disorders and Stroke through two U01 awards: U01 NS080168 and U01 NS08016. CREST-2 Registry is funded by NINDS-NIH and by Abbott Vascular, Boston Scientific, Cordis-Cardinal, W. L. Gore and Associates, Medtronic and Silk Road Medical.

Compliance with Ethical Standards

Conflict of Interest

Angelica R. Lackey, Young Erben, Joao Antonio Da Rocha Franco, James F. Meschia, and Brajesh K. Lal declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Angelica R. Lackey
    • 1
  • Young Erben
    • 2
  • Joao Antonio Da Rocha Franco
    • 2
  • James F. Meschia
    • 2
  • Brajesh K. Lal
    • 1
    Email author
  1. 1.Department of Vascular SurgeryUniversity of MarylandBaltimoreUSA
  2. 2.Department of NeurologyMayo ClinicJacksonvilleUSA

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