When Jim Birmingham was offered a chance to become the first patient at Froedtert & the Medical College of Wisconsin Froedtert Hospital to undergo a new procedure to clear a blocked carotid artery, he did some homework and decided to go for it.
“It seemed like there were fewer possible complications than with traditional methods,” said the energetic, 67-year-old village president of Greendale and owner of Broad Street Coffee Company. “And I’ve relied on the Froedtert & MCW health network for many years — and it has never let me down. I’m always willing to explore something new.”
Last August, vascular surgeon Peter Rossi, MD, along with vascular and interventional radiologist Robert Hieb, MD, performed a transcarotid artery revascularization, also known as TCAR, to clear Birmingham’s artery, which was about 70 percent blocked. During the groundbreaking procedure, blood flow through the carotid artery is reversed, which substantially reduces the risk of stroke.
“The procedure combines the best aspects of surgery and stenting,” Dr. Rossi said. “Because blood flow is reversed, debris that might break off travels backward out of the artery instead of into the brain.”
In simplified terms, TCAR is performed through a small incision near the collarbone to expose the carotid artery. The surgeon uses a tiny filter-equipped tube (outside the body) to connect the high-pressure artery to the low-pressure femoral vein in the thigh. The difference in pressure temporarily reverses the blood flow. Then a stent is inserted.
During the procedure, which takes about an hour and requires only local anesthesia, the brain receives sufficient blood from other arteries.
A blocked carotid artery is a major cause of strokes. Dr. Rossi said doctors typically have two other options: a carotid endarterectomy or stent placement. In the former, a surgeon cleans out the blockage through an incision in the neck. The stroke risk is low, but the surgery is invasive and can damage nerves that control swallowing and speech. The latter option involves inserting a stent through a small incision in the groin artery and advancing it through the aorta to the carotid artery. While less invasive than a carotid endarterectomy, it carries a higher risk of stroke.
Froedtert Hospital is the first medical center to offer TCAR in eastern Wisconsin. “I expect TCAR to become more common,” Dr. Rossi said. “It is the future in terms of stroke reduction.”
“I was up and about right away, and it didn’t even leave a scar,” Jim said. “I don’t feel light-headed anymore. I’m very grateful to Dr. Rossi. He was very honest and straightforward about the risks. He’s part of a great team that provides exceptional care.”