Editor's note:

In response to the Belt and Road Initiative, and with the aim of sharing expertise and addressing shared health challenges, our hospital has launched the Overseas Promotion Program for New Medical Technologies. If you are interested in any of the medical technologies covered under this program, please feel free to contact the International Cooperation Office at faowch@163.com.

TransCarotid Artery Revascularization (TCAR): A Pioneering and Safe Solution for Carotid Artery Stenosis

Introduction

TransCarotid Artery Revascularization (TCAR) is a innovative, minimally invasive hybrid procedure designed to treat carotid artery stenosis, a leading cause of ischemic stroke. By integrating a surgical approach with endovascular techniques, TCAR offers a paradigm shift in the management of this high-risk condition, particularly for patients unsuitable for conventional treatments.

Technical Innovation and Procedure

The defining innovation of TCAR is its proprietary dynamic flow reversal neuroprotection system. Prior to stent deployment, a closed-circuit connection is established between the carotid artery and the femoral vein. This temporarily reverses blood flow away from the brain, actively diverting any potential embolic debris released during the procedure into the venous circulation. This proactive cerebral protection mechanism represents a significant advancement over traditional distal filter devices used in transfemoral stenting.

Clinical Application and Outcomes

TCAR is primarily indicated for high-surgical-risk patients with significant symptomatic (>50%) or asymptomatic (>80%) carotid artery stenosis. Robust real-world registries and comparative studies have demonstrated outstanding clinical outcomes. The procedure is associated with peri-procedural stroke and death rates that are significantly lower than those of TransFemoral Carotid Artery Stenting (TF-CAS) and comparable to the historical gold standard, Carotid Endarterectomy (CEA). These excellent results are achieved while offering the benefits of a minimally invasive approach: a small incision, the potential for local or regional anesthesia, reduced procedural time, and faster patient recovery.

Global Health Relevance and Promotion Value

Stroke constitutes a massive and growing public health burden in many "Belt and Road" partner countries, where healthcare resources may be limited. TCAR holds exceptional promotional value for strengthening stroke prevention programs in these regions, characterized by three key advantages:

1.  Superior Safety Profile: The unparalleled cerebral protection of flow reversal makes TCAR an ideal technology for centers developing or expanding their cerebrovascular services. Its high safety margin can help elevate the overall standard of stroke prevention care, potentially reducing the devastating disability associated with procedural strokes.

2.  Broad Applicability: TCAR safely treats a wider patient population, including the elderly and those with complex aortic anatomy or unstable coronary artery disease who are often deemed unsuitable for both CEA and TF-CAS. This significantly expands access to life-saving intervention for vulnerable patient groups.

3.  Operational Efficiency: The procedure can be streamlined and is often quicker than CEA. This efficiency, combined with a minimally invasive profile, can lead to shorter hospital stays and faster recovery times. This is particularly beneficial for healthcare systems with limited bed capacity and resources, optimizing the use of critical infrastructure.

In summary, TCAR represents a significant advancement in carotid revascularization. Its unique safety mechanism, broad applicability, and operational efficiency make it a highly suitable and valuable technology for international collaboration and capacity building. The adoption and promotion of TCAR within "Belt and Road" partner countries can foster valuable clinical exchange, enhance local expertise, and ultimately contribute to the crucial goal of reducing stroke-related mortality and disability, improving neurological health outcomes across communities.