The use of a prosthetic vascular conduit during transcarotid artery revascularization

Transcarotid artery revascularization, or TCAR is an alternative to carotid endarterectomy for the surgical management of internal carotid artery stenosis. Not all patients with carotid disease are eligible for TCAR, as lesion anatomy must be compatible with current technology available for stent delivery. In this paper, we present two cases that utilized PTFE graft conduits to deliver a TCAR stent in patients who were not traditionally considered candidates for TCAR. In both patients, there was a short clavicle-to-bifurcation distance less than 5 cm, with one case having focally diseased access site requiring focal common carotid endarterectomy. Both of these cases were technical successes with no perioperative complications. Operative time was 138 minutes for the first case and 70 minutes for the second. Both patients were discharged on postoperative day 1 on dual antiplatelet therapy. The use of PTFE conduits to augment patient common carotid anatomy allows for safe and effective delivery of TCAR stents to patients with otherwise incompatible anatomy for TCAR.