TCAR — Trans Carotid Artery Revascularization in Sarasota & Bradenton
The Most Advanced Stroke-Prevention Procedure. Available Here, by an Experienced National Trainer.
Trans Carotid Artery Revascularization — known as TCAR — represents a major advance in stroke-prevention surgery. It combines the safety of direct carotid artery access with the minimally invasive benefits of stenting, and it does so with a built-in protection system that significantly reduces the risk of stroke during the procedure itself.
At Vascular Wellness Institute, Dr. Mariano Arosemena is one of the nationally recognized TCAR faculty members who trains both graduating vascular surgery fellows, experienced practicing vascular surgeons, cardiothoracic surgeons, interventional cardiologist, interventional radiologist and neurosurgeons in the safe and effective performance of TCAR procedures across the United States and Canada. For patients in Sarasota and Bradenton, this means access to one of the most experienced TCAR practitioners in the country, right in their community.
How TCAR Works
In traditional carotid artery stenting, the surgeon approaches the carotid artery from the groin, threading a catheter up through the aorta. This long route through the arch of the aorta increases the risk of dislodging plaque during the procedure. TCAR takes a different approach entirely.
With TCAR, a small incision is made at the base of the neck — directly accessing the carotid artery with a much shorter path. Before the stent is placed, a flow-reversal system is connected to the artery, temporarily redirecting blood flow away from the brain. Any plaque or debris that dislodges during stent deployment is captured by this system rather than traveling to the brain. The stent is then placed inside the narrowed artery under this protected condition, and normal blood flow is restored.
The procedure is performed under light general or regional anesthesia and typically takes about an hour. Most patients go home within 24 hours.
The Evidence Behind TCAR
TCAR’s safety profile is supported by the ROADSTER clinical trials — multicenter studies that demonstrated a significantly lower rate of peri-procedural stroke compared to traditional transfemoral carotid stenting. TCAR has been endorsed in clinical practice guidelines by the Society for Vascular Surgery for high-surgical-risk patients who need carotid revascularization but may not be ideal candidates for open surgery.
The ROADSTER-2 trial, published in the Journal of Vascular Surgery, reported a stroke and death rate of 1.4 percent — comparable to CEA in experienced hands, and lower than transfemoral stenting across multiple trials.
Who Is a Candidate for TCAR?
TCAR is particularly well-suited for patients who:
- Are at high surgical risk for open carotid endarterectomy (CEA) due to heart, lung, or other medical conditions
- Have anatomy that makes traditional transfemoral stenting higher-risk (tortuous aorta, unfavorable arch anatomy)
- Have significant carotid stenosis confirmed by imaging (duplex ultrasound, CTA, or MRA)
- Have had a TIA or stroke from carotid disease, or have asymptomatic high-grade stenosis
TCAR at Vascular Wellness Institute
Dr. Arosemena performs TCAR at HCA Florida Blake Medical Center in Bradenton and HCA Doctors Hospital in Sarasota. As a certified faculty proctor, he brings not only procedural expertise but a deep understanding of patient selection — knowing when TCAR is the right choice and when CEA or another approach would serve a patient better.
If you have been referred for carotid treatment or want a second opinion on your options, we are glad to review your imaging and walk you through what we recommend and why.