Stroke is the fifth leading cause of death in the United States, with well over 100,000 deaths annually. Approximately 87% of strokes are caused by a lack of blood flow to the brain, these are termed ischemic strokes. The main causes of ischemic strokes are fatty deposits (plaques) lining the brain’s blood vessels restricting flow (cerebral thrombus) or fatty deposits that break off from arteries in another location and travel to the brain inhibiting blood flow (cerebral emboli).
The carotid artery is the main artery supplying blood to the brain. Plaque has a tendency to build up at the carotid artery bifurcation and can break off, causing a stroke. Approximately one third of strokes are due to cerebral emboli from carotid arteries. Thus, carotid artery narrowing (stenosis) is closely measured in those patients at risk for a stroke or who have had stroke like symptoms. Once the narrowing reaches 50% in patients with stroke symptoms or 70% in patients without symptoms, it is recommended to undergo surgery to clean the artery (carotid endarterectomy [CEA]).
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The EnRoute Carotid Stenting system is a technology developed by Silk Road Medical which is used in the transcarotid approach to CAS. The Enroute system not only reverses the flow but allows the operator to control for the speed of blood flow. It harnesses the high pressure system of the artery and connects it with the low pressure system of the femoral vein in the leg—causing a reversal of blood flow in the arteries shunting blood to the vein.
The TransCarotid Artery Revascularization (TCAR) procedure is performed using the EnRoute transcarotid neuroprotection and stent system under sedation with a vascular surgeon. It involves making a small incision just above the collar bone to access the affected carotid artery. The EnRoute system is then inserted into the carotid artery and the other end is inserted into the common femoral vein. The flow reversal system is initiated, and the stent deployed into the carotid. After CAS, patients are usually observed overnight in the hospital.