What is TCAR?

TCAR – TransCarotid Artery Revascularization

Silk Road Medical introduces TransCarotid Artery Revascularization using the ENROUTE Transcarotid Neuroprotection and Stent System.  The TCAR procedure combines direct carotid artery access with robust blood flow reversal during ENROUTE Transcarotid Stent placement to remove micro and macro emboli throughout the intervention for CEA-like neuroprotection in a less invasive, more patient-friendly approach.

TCAR Procedure Details

A small incision is made just above the clavicle, exposing the common carotid artery. A sheath is placed directly into the carotid artery and connected to a system that will direct blood flow away from the brain to protect against plaque that may come loose and reach the brain. Blood will flow in the reverse direction through the system and any material will be captured in a filter outside the body. The filtered blood is then returned through a second sheath placed in the femoral vein in the groin.The system allows stenting and balloon angioplasty to be performed while blood flow is reversed. After the stent is placed successfully, flow reversal is turned off and blood flow to the brain resumes in its normal direction.

  • TCAR Procedure Animations

  • Disease, treatment options and TCAR Procedure
  • Disease, treatment options and TCAR Procedure

Microembolism Matters

  • Silk Road’s TCAR Procedure is designed to protect the brain from most sizes and types of emboli when delivering a stent. Small emboli, not large enough to cause a major stroke, can still cause a small brain infarction and impact cognitive function.1-3 A sensitive imaging technology called DW-MRI can be used to detect these small brain infarctions. Research studies on other neuroprotection devices have shown that filters placed in the artery beyond the disease (distal filters) may not adequately protect the brain from these microemboli.4 Distal filters, designed to capture plaque but allow blood to pass through them during the procedure, cannot stop the smallest debris from passing through.

Additionally, the process of placing the filter itself can create microemboli. In some research studies, 75-85% of patients undergoing CAS showed evidence of small brain infarctions post-procedure.5

The TCAR procedure is designed to mimic the safeguards of surgery with the benefit of a stent placement. In carotid artery surgery, the arteries are clamped above and below the blockage to block blood flow and prevent plaque from traveling to the brain during treatment. Similarly, the ENROUTE® Transcarotid Neuroprotection System  isolates the blockage from forward blood flow during stent placement by actually reversing blood flow away from the brain. Because the flow reversal method does not rely on a distally placed filter to capture emboli before they reach the brain, it collects both small and large debris.


1 Palombo G et al. AJNR Am J Neuroradiol 2008;29:1340-3
2 Wolf O et al. Eur J Vasc Endovasc Surg 2004;27:167-71.
3 Zhou W et al. J Vasc Surg 2009;50:1224-31
4 PROFI: Bijuklic et al. J Am Coll Cardiol 2012; 59:000–000
5 ICSS: Bonati LH et al.  Lancet 2010; DOI:10.1016/S1474-4422(10)70057-0.