Minimally Invasive Procedure Helps Reduce Stroke Risk

May 10, 2023

Stroke Prevention: Transcarotid Artery Revascularization, Valley Health System, Las Vegas, NV.

Retired Apollo Lunar Module engineer John Davis is on a new mission – to save lives by sharing the importance of getting your carotid arteries checked.

“I was 83 and had never had my carotid artery tested,” explained Davis. “My primary care physician suggested it, and when the results came back with severe, significant blockage, he recommended that I see a vascular specialist.

“I made an appointment with Dr. Eddy H. Luh of Vegas Vascular Specialists, which was the best thing I could have done,” continued Davis. “He ordered a CT angiogram, which is a more thorough test, and discovered I had an almost 90% blockage in my left artery and over 50% blockage in my right artery. If you’re over 50%, you should definitely get it evaluated.”

After a thorough discussion with Dr. Luh, a board-certified vascular surgeon and Chief of Surgery at Valley Hospital, Davis opted for the transcarotid artery revascularization (TCAR) procedure. “TCAR is considered a game changer in the treatment of carotid artery disease. It is intended to decrease stroke risk and has demonstrated it could be a safer procedure than the current standard of carotid endarterectomy in intraoperative risks, perioperative strokes, myocardial infarction and cranial nerve injury risks,” explained Dr. Luh.

Blood flow, according to Dr. Luh, is the circulatory system, or “plumbing” of the body. “Clean arteries and veins are important in order to ensure adequate blood flow to the various organs and structures throughout the human body,” he said.

“Unfortunately, a significant number of people will have a stroke as the first symptom of carotid disease,” Dr. Luh continued. “Some people will have what is called a transient ischemic attack (TIA) or mini-stroke. Others will be completely asymptomatic (no symptoms). The only way they will know they have significant narrowing is with some radiology studies.”

The goal of carotid intervention, explained Dr. Luh, is stroke prevention. “TCAR has demonstrated a perioperative stroke risk rate of less than 2%, along with reduced complications of possible temporary cranial nerve injury with less than 2%.”

He noted the traditional carotid endarterectomy has about a 2-3% chance of perioperative stroke and a 6-9% chance of temporary cranial nerve injury when performed by a board-certified vascular surgeon. A third option, the transfemoral carotid stent, has demonstrated a 6-10% chance of perioperative stroke. Percentages are higher when performed by a non-board-certified vascular surgeon.*

About the TCAR Procedure

The procedure takes about an hour to complete and patients will stay, typically for one night, in the surgical intensive care unit at Valley Hospital.

The procedure begins with a small incision made above the collarbone to allow access to the carotid artery. Then a short hollow tube (sheath) is placed temporarily in the carotid artery. To protect the brain from debris during the procedure, a circuit outside the body directs the blood flow away from the brain and back into a vein in the leg. This process is called “reverse flow,” which then allows the physician to place a stent at the location of the narrowing of the carotid artery for long-term plaque stabilization and stroke prevention.

While most people remain hospitalized for at least one day, it all depends upon the patient, and she or he may stay an extra day and/or be transferred to a different nursing unit before leaving the hospital.

“I had some anxiety but the next thing I knew, I woke up in the recovery unit. I felt excellent!” said Davis. “I even asked the nurse if they did the procedure because I had no discomfort. When they rolled me back to intensive care, I told my wife I felt fine.

“The more I learned about carotid arteries, it dawned on me that people have no idea they might have problems because there are no symptoms. If you haven’t had it checked, do it! Your PCP can do a carotid ultrasound. That’s the only way you’ll find out unless you have a stroke. If you have not had your carotid arteries checked, just do it. It could be lifesaving!”

Carotid Arterial Disease Is Part of Atherosclerosis

Equally important to understand is that carotid arterial disease is part of a larger systemic disease known as atherosclerosis. “Atherosclerosis is a systemic disease, not a regional disease,” explained Dr. Luh. “Therefore, when someone develops vascular disease in one vascular bed (area of the body) such as the carotids, the heart or the lower extremities, there is about a 20% chance, if not more, that they have significant disease in another vascular bed.”

This proved true for John, who had additional vascular procedures on both legs in February due to the narrowing of his iliac arteries that was compromising blood flow.

“I had a sore toe, which was slow to heal,” he explained. “The podiatrist said it was due to limited blood flow in my leg and I needed to see a vascular surgeon. It’s interesting how you find these things – I had a sore toe and ended up having vascular surgery on both legs,” said Davis. The procedure included having stents placed in both his aorta and iliac arteries to relieve the narrowing and improve blood flow in both legs.

To Davis, Dr. Luh was one of the most important people in his health care journey. “He is such a gentleman and delightful person to talk to – from the first moment in his office, I knew he was a top-notch surgeon. Very professional, very considerate.”

Plus, the two share an avid interest in space exploration. While chatting during their appointment, John shared he worked on the Apollo lunar program, which was the first time America went to the moon. “I worked for Grumman Aerospace, the company that built the Lunar Module, as a radar test engineer,” said Davis. “I was at Cape Canaveral for all the launches.”

John has had an interest in planes for most of his life. “My passion growing up was airplanes, and I flew recreationally for about 20 years.” Before retiring, he worked as a field support engineer for Grumman, often deploying on aircraft carriers and, in later years, piloting an RV around the US and Canada with his wife of 36 years, Cora, by his side.

These days, he stays closer to home, honing his woodworking skills in his wood shop, specializing in jewelry boxes. “I could spend all day out there,” he declared.

And thanks to good blood circulation, he certainly can.

TCAR is also available at Centennial Hills Hospital, another hospital in The Valley Health System.

TCAR at Valley Hospital → 

*Source: Journal of Vascular Surgery