Mercy's Vascular Surgeons Perform Innovative TCAR Procedure to Treat Carotid Artery Disease

January 25, 2021

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Mercy Medical Center, Baltimore, MD has performed its first TransCarotid Artery Revascularization (TCAR) procedure this week, a clinically proven, minimally invasive and safe approach for high surgical risk patients who need carotid artery treatment. Mercy vascular surgeons Drs. Paul Lucas, Vincent Noori, and Gabriel Pereira performed the procedure.

Carotid artery disease is a form of atherosclerosis, or a buildup of plaque, in the two main arteries in the neck that supply oxygen-rich blood to the brain. If left untreated, carotid artery disease can often lead to stroke; it is estimated to be the source of stroke in up to a third of cases, with 427,000 new diagnoses of the disease made every year in the U.S. alone.

“For patients with carotid artery disease like carotid stenosis, there have been two options for surgical treatment: carotid endarterectomy (CEA), or stenting. Both are effective, but there is a risk of stroke during the procedure. Now, however, there is a new minimally invasive approach called transcarotid artery revascularization (TCAR) which offers the same results, but with a faster recovery, lower risk of stroke, heart attack and cranial nerve injury,” said Paul R. Lucas, M.D., FACS, RPVI, DirectorThe Vascular Center at Mercy

“Because of its low stroke risk and faster patient recovery, I believe TCAR may represent the future of carotid repair,” Dr. Lucas added.

According to Dr. Lucas, TCAR uses a device from Silk Road Medical to briefly reverse the direction of blood flow during surgery. With blood (and any clots) flowing away from the brain, the patient's risk of stroke is lower.  

“TCAR is unique in that blood flow is temporarily reversed during the procedure so that any small bits of plaque that may break off are diverted away from the brain, preventing a stroke from happening. A stent is then placed inside the artery to stabilize the plaque, minimizing the risk of a future stroke. Being a less invasive option, this procedure offers a shorter hospital stay, less post-operative pain and improved cosmetic results. In addition, with similar results as traditional open surgery, it may now be an option for patients who were otherwise not candidates for open surgery due to other medical reasons," explained Mercy vascular surgeon Vincent J. Noori, M.D., RPVI.

“TCAR is an important new option in the fight against stroke, and is particularly suited for the large portion of patients we see who are at higher risk of complications from carotid surgery due to age, anatomy, or other medical conditions,” said vascular fellow Gabriel Pereira, M.D.

Dr. Lucas noted that, unlike the minimally invasive TCAR, carotid endarterectomy (CEA) is an open surgery procedure that requires a large incision, leaving a visible scar the length of the neck.

“In addition, CEA carries risks of surgical complications, including bleeding, infection, heart attack and cranial nerve injuries that can cause issues with swallowing, speaking and sensation in the face.  TCAR eliminates these issues, and is a much more elegant procedure,” he said.

The TCAR procedure was developed by Sunnyvale, California-based Silk Road Medical, Inc. and includes the ENROUTE® Transcarotid Neuroprotection (NPS) and Stent System – the first devices designed and FDA-approved specifically for TCAR. Over 20,000 TCAR procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent. Additional information about TCAR is available at


About Mercy

Founded in 1874 in Downtown Baltimore by the Sisters of Mercy, Mercy Medical Center is a 183-licensed bed, acute care, university-affiliated teaching hospital. Mercy has been recognized as a high-performing Maryland hospital (U.S. News & World Report); has achieved an overall 5-Star quality, safety, and patient experience rating (Centers for Medicare and Medicaid Services); is A-rated for Hospital Safety (Leapfrog Hospital Safety Grade); and is certified by the American Nurses Credentialing Center as a Magnet™ hospital. Mercy Health Services is a not-for-profit health system and the parent company of Mercy Medical Center and Mercy Personal Physicians.

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