In the United States, someone suffers from a stroke every 40 seconds while someone dies every three to four minutes. Yet, up to 80% of strokes are preventable. CTVS vascular surgeons are using a newer, less invasive procedure, TransCarotid Artery Revascularization (TCAR), that can help prevent a stroke in patients with a known carotid artery blockage.
In a recent interview with Nicole Villalpando in the Austin American Statesman, CTVS patient Stephen Galloway shares how the TCAR procedure, performed by vascular surgeon Dr. Taylor Smith, helped him see in color again after experiencing a stroke. You can read the entire article below or find it on the Austin American Statesman website here.
Two years ago, Stephen Galloway noticed that his vision was losing color and that it looked as if he were seeing the negative of a roll of film. Doctors couldn’t find the cause.
They thought perhaps it was a long-term effect of an explosion at a chemical spill he was helping clean up in 1991. That explosion left him with neuropathy in his hands, the top of his head and his bladder as well as lung damage. Perhaps it was the significant amount of steroids he’d had to take to recover from that accident.
Then this spring, the 65-year-old from Dale — a small community east of Lockhart in Caldwell County — had a stroke and was treated with a relatively new technique: Transcarotid Artery Revascularization, which puts a stent in the carotid artery but actually reverses the blood flow momentarily to be able to capture any plaque or clotting that comes loose while the stent is being placed. Doctors say the procedure can lessen the risk of a second stroke during the procedure and reduces the risk of another stroke later.
The day Galloway’s stroke happened, he had just walked across his 3-acre property to talk to a neighbor and was returning home. He didn’t feel quite right.
“All of the sudden, my right side went,” he said. “It collapsed on me, and I ended up on the ground.”
He rolled over to the nearest tree and pulled himself up. He eventually got home after collapsing a second time.
Then he checked on the internet and found that he had all the symptoms of a stroke:
When it comes to a stroke, think BE FAST: Balance (difficulty balancing or walking), Eyes (difficulty seeing out of one or both eyes), Face drooping, Arm weakness, Speech difficulty, Time to call 911.
In Spanish, AHORA: Andar (walking: difficulty balancing or walking), Hablar (speaking: difficulty understanding or speaking), Ojos (eyes: a change in vision), Rostro (face: a face droop or worst headache of your life), Ambos brazos (both arms, difficulty lifting, or a weakness in an arm or leg).
Galloway’s wife, Sandra, took him to Ascension Seton Medical Center Hays in Kyle, where he was diagnosed with a stroke. He got there in time to get antiplatelet medicine and blood thinner to protect against further damage. Doctors began figuring out what kind of stroke he’d had and where it was.
Waiting for artery to be opened
For the next two days, Galloway was in the hospital recovering from the stroke and letting his brain recover before having the Transcarotid Artery Revascularization procedure, which is commonly called TCAR.
“You need the brain to rest and recover at least two days before you do something,” said Dr. Taylor Smith of Cardiothoracic and Vascular Surgeons. “Patients have a worse outcome if you intervene less than 48 hours.”
Often, though, Smith can do the procedure in the same hospital visit after waiting that 48 hours.
TCAR is specifically designed for people who have blockages in their carotid artery causing their strokes. In Galloway’s case, one of his arteries was partially blocked and another one was almost completely blocked, but he had two arteries in the back of his head leading to the brain that were OK. Doctors decided to put a stent in the one that wasn’t as blocked and left the other one alone to prevent further damage to it.
TCAR won’t reverse any of the damage caused by a stroke, but it can prevent strokes as well as open up blood flow to the brain. Most people with a carotid artery blockage can have this done, Smith said. But if there has been significant damage caused by a stroke that has left a patient incapacitated, doctors won’t do the procedure because it cannot reverse that damage or improve quality of life significantly, Smith said.
How TCAR works
When performing the TCAR procedure, Smith cuts a small hole in the patient’s neck near the carotid artery. He puts in a sheath about the size of an IV needle into the carotid artery. That sheath is connected to SilkRoad Medical’s EnRoute circuit system outside the body that directs the blood to flow away from that artery and toward the femoral vein in the leg.
The blood flow is reversed for only about five to 10 minutes, Smith said. Meanwhile, the brain is being fed by other arteries.
Once the blood flow is reversed, Smith is able to put in a stent made of nickel and titanium through that same sheath. The artery is now stabilized. Any plaque that breaks loose flows to the filter system in the sheath, rather than to the brain.
Once the stent is placed, Smith removes the sheath and closes the artery and hole in the neck.
When Galloway woke up after having the procedure, he said, he began seeing flashes of color again. It took a few days to stabilize, but now he sees in color — an indication that the blockage in his artery and the lack of blood flow to the part of his brain where vision is housed were causing the change in his vision. Smith agreed that the blockage was to blame for the vision issue.
Galloway said he didn’t think he was at risk for a stroke. His family doesn’t have a history of them, he said, nor was he a smoker, though he does have significant lung damage from the 1991 accident.
“In a sense, it was ❛here I go again,’” he said about the stroke and being hospitalized again after all the years of recovering from that accident.
Procedure can be done before a stroke
Galloway said that based on medical scans, he’d been having ministrokes leading up to the stroke.
People don’t have to wait until they have a stroke to have a stent placed through TCAR, Smith said. People with an elevated risk of stroke because of family history, a history of smoking or another risk factor can have an ultrasound of their carotid arteries to see what blockage might be there. They can then have a stent placed preemptively.
A stroke, Galloway said, “is an experience I don’t wish on anyone.”
He is now getting back to normal, everyday activities, he said. Years ago, while recovering from the explosion, he said, he learned, “You get busy living or you get busy dying.”
He chooses living.