MDT at Renmin Hospital of Wuhan University Successfully Performs TCAR for High-Risk Severe Carotid Stenosis

Case Overview

Recently, a multidisciplinary team (MDT) comprising neurosurgery, cardiovascular departments, and anesthesiology at Renmin Hospital of Wuhan University successfully performed a TransCarotid Artery Revascularization (TCAR) on an 80-year-old patient. The patient presented with severe carotid stenosis and significant cardiovascular comorbidities, accompanied by near occlusion of the right internal carotid artery and marked cerebral hypoperfusion.

Treatment Decision & Technical Pathway

Given the patient's advanced age and complex underlying conditions, traditional Carotid Endarterectomy (CEA) was deemed poorly tolerated. Conversely, traditional transfemoral Carotid Artery Stenting (CAS) carried an unacceptably high risk of intraoperative stroke due to plaque embolization. The clinical team elected to utilize TCAR, an advanced hybrid procedure, to achieve the highest level of neurovascular protection with minimal surgical trauma.

Surgical Execution & Technical Details

• The surgical team directly exposed the common carotid artery via a 2.5 cm cervical incision, bypassing complex catheter navigation within the aortic arch and thereby reducing the risk of vessel wall injury.
• A "Flow Reversal" neuroprotection circuit was successfully established. Throughout balloon angioplasty and stenting, the internal carotid artery flow was maintained in a retrograde direction, effectively capturing and filtering any procedure-induced micro-emboli.
• The seamless integration of surgical exposure and interventional techniques allowed the entire procedure to be completed in under one hour.

Clinical Outcome & Conclusion

Postoperative angiography confirmed complete restoration of patency in the internal carotid artery and successful reconstruction of the cerebral blood supply. The patient exhibited entirely normal neurological function (NIHSS score: 0) and was discharged smoothly on postoperative day 5. The success of this case highlights the critical role of MDT collaboration in managing complex, high-risk vascular lesions and confirms the significant clinical advantages of TCAR in mitigating perioperative stroke risks.