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E2335. A Trainee's Guide to Transcarotid Artery Revascularization (TCAR): A New Landscape in Carotid Intervention
Authors
  1. Harkanwar Gill; University of Oklahoma Health Sciences Center
  2. Natalie Shahbazi; University of Oklahoma Health Sciences Center
  3. Feroz Maqbool ; University of Oklahoma Health Sciences Center ; VA Health Care System
  4. Joshua Gierman ; University of Oklahoma Health Sciences Center ; VA Health Care System
Background
Carotid artery atherosclerosis is a potentially treatable pathology that can result in high grade stenosis and manifest as recurrent cause of ischemic stroke (1). Traditionally, carotid endarterectomy (CEA) and carotid artery stenting (CAS), are among the most common revascularization procedures performed worldwide. Over the last few years, another endovascular procedure, Trans Carotid artery Revascularization (TCAR) has emerged as a promising technique for treatment of high-risk patients who are not good candidates for CEA and technically difficult for trans femoral CAS (2,3). This procedure is not widely available in many hospitals across the country. Our institution is among a few hospitals in Oklahoma performing this hybrid surgery.

Educational Goals / Teaching Points
A) Review current imaging and treatment options for carotid artery disease. B) Discuss landmark studies published on TCAR. C) Understand anatomic considerations, advantages and limitations of TCAR.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A) Understand the technical aspects of TCAR using ENROUTE Neuro protection System (NPS) device. B) Discuss pre and post operative imaging and follow up.

Conclusion
TCAR with the ENROUTE Neuro Protection System (NPS) and stent should be considered for treatment of high-risk patients who are not good surgical candidates for carotid endarterectomy or technically difficult for trans-femoral carotid stenting.