Ann Keetch went to the dentist last year to address an impacted wisdom tooth.
But her dentist saw that something more severe might be wrong after an X-ray, and she was sent to the emergency room to address what ended up being severe plaque buildup in a carotid artery, a vessel that carries blood to the head and neck.
“I will give all the credit to my dentist,” said Keetch, 81.
People who have a blockage of their carotid artery or carotid artery disease face a higher risk of stroke since the artery directly delivers blood to the brain. Before 2018, the main treatment came with its own risks: If pieces of the clogged debris were displaced during the procedure and traveled to the brain, it could cause a stroke. Patients also faced long recovery times.
But a new procedure fixes these problems. Keetch became one of the first patients in Charleston to undergo a less-invasive procedure known as "transcarotid artery revascularization" (often called "TCAR") at Roper St. Francis. The Medical University of South Carolina introduced this surgery to its patients last year, too.
“What we want to do is provide safer options for patients,” said Dr. Sean Hislop, a vascular surgeon at Roper St. Francis.
According to the Society for Vascular Surgery, around 3 percent of people over 65 have carotid artery disease. One-third of all strokes occur as a result.
When the blockage in the carotid artery isn’t severe, the most common procedure to handle the issue has been a carotid endarterectomy, or CEA. During this procedure, a large incision is made in the neck, the plaque is removed, the artery is repaired, and the incision is closed.
In cases when the blockage is severe — like with Keetch — it may call for stenting. An incision is made in the groin and a catheter is guided all the way to the neck to the carotid artery. From there, a stent is placed that manually expands the artery to increase blood flow. It's during this expansion, Hislap explained, there is a small chance that debris can break off and reach the brain.
Dr. Ravi Veeraswamy, chief of vascular surgery at MUSC, said the TCAR procedure inserts the stent in a less risky way through a smaller incision. Surgeons aren't required to guide the catheter through the groin, and the risk of stroke is reduced because the patient's blood flow is reversed. This guides any debris in the opposite direction of the brain toward a filtration device connected outside of the body. The filtered blood is returned through an incision in the leg.
“It allows placement of the stent and avoids both of those issues,” he said.
Dr. Hislap said this has resulted in a significant reduction in the stroke rate in comparison to other stenting procedures. With traditional stenting, the risk of stroke was around 3 percent, he said.
The TCAR procedure reduces the risk to less than 1 percent. The surgery is also much shorter, taking around seven minutes. Traditional stenting takes nearly 45 minutes.
“It allows us to treat patients who are sicker, with higher risk for complications, in a safer manner,” Hislap said.
Elaine Newcomb has experience with both the old and new procedures.
Last June, she underwent the traditional carotid endarterectomy at a hospital in Myrtle Beach. The recovery time for that procedure lasted three months, and she needed staples to repair the incision.
When her doctor found an additional blockage, she was referred to MUSC. She said she made it a point to ask Dr. Veeraswamy, who operated on her in November, enough questions to ensure that her second recovery would take as long.
“The only thing I didn’t want was a stroke on the table,” she said.
After TCAR surgery in November, she said she recovered in around 10 days.
“It didn’t feel like major surgery to me,” she said. “To me, it was just like 'Wow.'”