Optimal Cerebral Protection Confirmed by Transcranial Doppler During Transcarotid Artery Revascularization

Transcarotid artery revascularization (TCAR) is a novel method to treat severe stenosis of the carotid artery with minimal embolization. During TCAR, flow reversal system redirects blood from the internal, external, and common carotid arteries into the femoral vein through a filter system to prevent debris and microparticles from entering the cerebral circulation. Transcranial Doppler (TCD) monitoring allows real-time detection of blood flow in the cerebral arteries during the operation and informs the surgeon of flow changes or possible emboli. With this information, the steps and maneuvers during the procedure and the function of the flow reversal system can be further improved to avoid stroke or other neurological complications. In this case study, we present a TCAR procedure with TCD monitoring in an asymptomatic male patient exhibiting severe left-sided internal carotid artery stenosis. Optimal cerebral protection was achieved due to the neuroprotective flow reversal system of TCAR.