Transcarotid Artery Revascularization (TCAR)

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Transcarotid artery revascularization (TCAR) is a minimally invasive procedure that treats carotid artery disease by removing plaque blockages and restoring blood flow, which can help reduce your risk of stroke.

UPMC experts are national leaders in performing pioneering TCAR procedures, offering a less invasive option to reduce the risk of stroke in people who may not be candidates for traditional procedures to treat carotid artery disease.

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What Is TCAR?

Your carotid arteries are located on either side of your neck and supply oxygen-rich blood to your brain. These arteries can become narrowed due to plaque buildup. If a piece of plaque breaks off, it can cause a stroke. Transcarotid artery revascularization (TCAR) is a minimally invasive procedure that treats carotid artery disease by removing plaque blockages and restoring blood flow, which can help reduce your risk of stroke.

TCAR can also be performed as an alternative to traditional surgery to treat carotid artery disease in people who are at high risk of experiencing complications.

Is TCAR the same as carotid stenting?

TCAR and carotid stenting procedures both involve placing metal mesh tubes called stents to keep your carotid artery open after a blockage has been removed. However, in TCAR, the stent is inserted through an incision near your collarbone. In carotid stenting, the stent is inserted through an incision in your groin or arm.

Conditions we treat with TCAR

Carotid artery disease.

Why Would I Need TCAR?

Your doctor may recommend TCAR if you have carotid artery disease caused by deposits of a fatty substance called plaque. Plaque deposits narrow the arteries and can break off, increasing your risk of stroke.

Who’s a candidate for TCAR?

You may be a candidate for TCAR if you are at high risk of experiencing complications during a traditional carotid artery revascularization procedure, such as carotid endarterectomy or carotid stenting.

Alternatives to TCAR

What Are the Risks and Complications of TCAR?

TCAR is a safe procedure.

However, like all surgical procedures, it comes with some risks, including:

Bleeding, bruising, or swelling at the incision site.
Damage to your carotid artery.
Heart attack.
Nerve damage.
Stroke.

What Should I Expect From TCAR?

During your first visit, your doctor will go over your medical history and perform a physical exam.

You may also have a series of tests, including:

Angiography — An invasive test that uses special x-ray imaging to accurately find artery blockages.
Magnetic resonance angiography (MRA) — Provides detailed imaging through radiofrequency waves in a magnetic field.
Ultrasound —Produces images using sound waves and determines the extent of the narrowed artery and the blood flow to the brain.

Before: How to prepare for TCAR

Your doctor will explain the TCAR procedure to you and answer your questions.

To prepare for the procedure, you should:

Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure.
Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
Fast for a certain period before the procedure. Your doctor will tell you how long to fast (usually overnight).
Have any tests that your doctor recommends. For example, your doctor may request a blood test before the procedure to determine how long it takes your blood to clot.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You will need to stay in the hospital overnight after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.

How long does TCAR take?

TCAR procedures typically take about 90 minutes.

During your TCAR procedure

You may receive local anesthesia so you don’t feel any pain at the incision site or general anesthesia to put you to sleep.

During the procedure, your doctor will:

Make an incision near your collarbone.
Insert a thin, flexible tube called a catheter through the incision and into your carotid artery.
Connect a filtering device that prevents pieces of plaque from traveling to your brain during the procedure and causing a stroke.
Reverse blood flow away from your brain so it travels through the filter, reducing stroke risk during the procedure.
Insert a special device with a balloon at the tip and guide it to the site of the blockage.
Inflate the balloon to push the blockage to the side, restoring blood flow to your brain.
Insert a metal mesh tube called a stent to hold your carotid artery open.

After blood flow is restored, your doctor will remove the catheter, filter, and other devices and close your incision.

Recovery after TCAR

After your TCAR procedure is complete, you will be moved to recovery and then admitted to the hospital. You should be able to go home the next day.

You should ask your doctor when you can return to work and resume everyday activities. You may be instructed not to drive for a certain amount of time after your procedure.

It is very important that you see your doctor for follow-up visits as recommended. Your doctor may schedule you for follow-up duplex ultrasound exams to monitor your carotid arteries.

Your surgeon will recommend lifestyle changes, like:

Eating a healthy diet.
Getting regular exercise.
Quitting smoking.

Your doctor may also recommend medicines to help control your cholesterol or blood pressure and help prevent future blockages.

When to call your doctor about post-op problems

You should call your doctor if you are experiencing any unusual symptoms, including:

Fever of more than 100.0°F.
Numbness on one side of your body.
Pain, redness, bleeding, drainage, or increased swelling at the incision site.
Trouble walking or speaking.

If any of these symptoms are severe, you should dial 911 immediately.

What’s the prognosis after TCAR?

For most patients, TCAR restores blood flow to the brain and helps reduce stroke risk.

Is TCAR better than CEA?

TCAR is another treatment option that is often used for patients who are at high risk of complications during a CEA procedure. Preliminary TCAR research shows that the procedure is as safe as CEA and delivers outstanding outcomes.

What’s the success rate of TCAR?

TCAR is a newer procedure, so research has not yet been done to show long-term outcomes. However, TCAR is successful in removing blockages in the carotid artery and restoring blood flow to the brain.

Why Choose UPMC for TCAR?

When you choose UPMC for your TCAR procedure, you will receive:

Access to board-certified specialists — Our vascular surgeons are among the nation’s most experienced at performing pioneering TCAR procedures.
Expert diagnosis and personalized care — Our team will develop a customized treatment plan to reduce your risk of complications and improve your quality of life.
A full range of treatment options — We use the latest nonsurgical, minimally invasive, and surgical techniques to provide comprehensive care for carotid artery disease.

By UPMC Editorial Staff. Last reviewed on 2025-10-23.

Society for Vascular Surgery