Overlook becomes first hospital in state to use new stroke reduction procedure

Illustration Courtesy of Atlantic Health System’s Overlook Medical Center
TCAR — The smaller incision on the right results from the new TCAR surgery, while the larger incision on the left is from a more traditional method of carotid artery surgery.

SUMMIT, NJ — A new preventive procedure that is more accessible to seniors is now offered at Atlantic Health System’s Overlook Medical Center, helping patients to reduce the risk of stroke.

The procedure is known as transcarotid artery revascularization, or TCAR, and is a minimally invasive operation that uses a stent to open up and reduce blockage of the main artery in the neck. The surgery leaves about a 1-inch wide incision near the collarbone.
“They stay in the hospital one night and they go home the next day,” said Dr. Scott Sundick in an Oct. 20 interview. He has performed the procedure seven times since it was implemented at Overlook three months ago.

The Summit hospital is the first in the state to use this new, FDA-approved approach in stroke prevention, said Sundick, a vascular surgeon who has been practicing medicine for five years.

Up to 3 percent of people older than 65 have carotid artery disease, according to the Society for Vascular Surgery. Carotid artery disease is a major factor contributing to approximately 795,000 strokes each year in the U.S., according to the Stroke Center. Nearly three-quarters of all strokes occur in people older than 65.

Two other stenting procedures — transfemoral carotid stenting and carotid endarterectomy — already exist, but are more invasive.
One begins with an incision in a main artery located in the groin and inserts a long catheter that must pass through the aorta to reach the neck artery. The other begins with an the incision in the neck, much like TCAR, but leaves a larger scar and carries more risks of serious complications.
Older patients, Sundick said, may not be good candidates for the procedure that begins in the groin because the surgery passes along the area of the aorta, which could be more diseased later in life.

The two older procedures are currently offered at Overlook and are not necessarily easier, Sundick said, but may be more suitable for different patients based on their individual needs.

However, TCAR could become standard care for all patients because of the procedure’s low stroke risk.
“We’re essentially doing something that we’ve done in a different way that’s safer and more approachable to have more patients have it done,” Sundick said.

The procedure is considered safer since it temporarily reverses blood flow in the neck artery while inserting the stent, according to a release from the hospital.

This diverts potential plaque and blood clots that could travel to the brain during the operation, which could cause the very thing the operation is trying to prevent: a stroke.

The procedure, which can be done while the patient is awake or sedated, was developed by Silk Road Medical, a California-based company that worked with the vascular surgery community for 10 years to design the operation.

A new program in collaboration with groups including the Food and Drug Administration provides expanded insurance coverage of this newest procedure for Medicare recipients. The program, known as the “TCAR Surveillance Project,” also allows hospitals and the Society for Vascular Surgery to track quality benchmarks.

“We make a lot of difference in all the operations we do,” Sundick said of his surgical work. “But when you’re dealing with the brain, it’s more stressful because the possible downfall is you can have a stroke. But it’s equally more rewarding when they don’t.
“And when you’re removing a person’s risk of stroke, it’s great.”