Less invasive surgery now a treatment option for patients with carotid artery disease



FLINT – It is time for your yearly checkup and as far as you know you are in good health. Your primary care physician wants you to have an ultrasound to check your carotid arteries. Unfortunately, the results show severe blockage on one side, making you high risk for a stroke.

This was the case for James Dell, 73, of Kimball, located just west of Port Huron. Fortunately, a less invasive, more patient-friendly treatment option called Silk Road Transcarotid Artery Revascularization (TCAR) was available to him. Michigan Vascular Surgery physicians at McLaren Flint have adopted the new procedure which has benefits over other traditional methods. On March 7, they performed the first Silk Road TCAR in Michigan on Mr. Dell as part of the Roadster 2 trial, and are the only group of physicians in the State of Michigan to offer this latest innovation to patients. Every year, more than 300,000 people in the United States are diagnosed with blockages, or plaques, in their carotid artery. If left untreated, these blockages can occlude or can fragment, resulting in particles flowing to the brain, and lead to a potentially disabling stroke which is a leading cause of death and life-altering disability in the United States.

The most widely utilized treatment option for severe carotid artery disease involves an open surgery known as carotid endarterectomy (CEA). This option has proven quite effective in preventing stroke during and after the procedure, but carries risks of surgical complications like heart attack and injury to nerves that are near the carotid artery. In addition, and based upon the experience provided by the surgeons at Michigan Vascular at McLaren Flint, carotid artery stenting from a femoral arterial approach (the main artery in the groin) is also now approved for some patients with the presence of carotid artery disease. However, any repair of the carotid artery carries some risk of causing a stroke as a result of the repair itself. The Silk Road TCAR procedure was designed to lower that risk.

“Like CEA, the Silk Road TCAR procedure involves direct access to the common carotid artery but through a much smaller incision above the collarbone creating just enough room to place a sheath into the artery and deliver a stent,” states Dr. Robert Molnar, Vascular Surgeon.

“This novel Transcarotid access path is designed to allow for use of local anesthesia, minimize the rate and severity of nerve injury, minimize scarring on the skin, avoid potential stroke complications seen from the femoral arterial approach, and speed the recovery process for an overall more patient-friendly procedure.”

During the Silk Road TCAR procedure, blood flow is temporarily reversed in the carotid artery to divert dangerous debris away from the brain, preventing a procedural stroke. During the intervention, a stent is implanted in the carotid artery to open and stabilize the narrowing. The stent protects patients from future stroke risk. This is now a treatment option for patients who are high risk for stenting due to anatomical concerns which include disease of the aortic arch, severe vessel tortuosity and unfavorable distal vessel anatomy.

The Michigan Vascular Center surgeons can now tailor make the best approach for treating patients with carotid disease based upon their medical factors and anatomical factors. They are also one of the few centers in the country participating in the NIH sponsored CREST 2 trial.

Treatment options for carotid disease now include best medical therapy, surgical carotid endarterectomy, transfemoral carotid artery stenting and the Silk Road transcarotid artery revascularization. The surgeons at Michigan Vascular Center are leading the way in optimizing the patient experience and exceptional outcomes. — G.G.


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