1. Transfemoral CAS and TCAR
Carotid Stenting
Transfemoral CAS and TCAR
Leila Mureebe, MD, MPH, FACS
Division of Vascular and Endovascular Surgery
Duke University Health Care

2. Agenda:
I. Inclusion/Exclusion Criteria II. Anatomy & Physiology Overview III. Live abstraction

3. Inclusion/Exclusion Criteria:
Carotid artery stents that involve the carotid bifurcation or are isolated to the internal, external, or common carotid artery that may be performed by percutaneous or open (cut down) approach. Both primary and redo stenting is included. Unlike other procedures, stenting for trauma is also included.
Typically, the carotid bifurcation or internal carotid artery is treated, but sometimes an isolated common carotid stenosis is treated alone, or in combination with a bifurcation/internal carotid stent. Rarely the external carotid is treated but we are including it to meet CAS recertification requirements.
The data entry form allows any of the four locations to be recorded for compliance with CMS Carotid Stent reporting. If the procedure failed when attempting to place the long sheath in the CCA, this should be recorded as a “technical failure” on the procedure tab.
If bilateral Carotid Artery Stent procedures are done on the same day, please enter as two separate procedures.
Exclusions
Intracranial Carotid Artery stents (above C1)
Carotid Artery Stents placed for bleeding or infection

4. Carotid Anatomy and Physiology
Source: Wikimedia Commons

5. Arch Anatomy

6. CAS Example

7. TCAR

8. Dynamic Flow Reversal For ROBUST Neuroprotection
Direct carotid access reduces embolic risks of transfemoral catheter advancement
Continuous high rate of flow reversal to remove debris throughout intervention
A new, surgically inspired, endovascular solution for carotid artery revascularization comes to us from Silk Road Medical. Through a small surgical cutdown, the ENROUTE Transcarotid Stent and Neuroprotection Systems deliver an endovascular dynamic flow reversal system for continuous, robust stroke protection. This new, direct carotid access method provides surgical patient outcomes with unique transcarotid speed and control. The avoiding the more critical crainial nerve bundle in the typical longer CEA incision.
CAUTION: Investigational device. Limited by federal (USA) law to investigational use. The ENROUTE™ Transcarotid Stent and Neuroprotection Systems bear the CE mark of conformity and are available for sale in EU and EFTA countries.

9. Filter Contents

10. TCAR Indications and Contraindications : Focus on Safe Access

11. Case Abstraction: Transfemoral CAS
USER: VAM2019
Password: #1registry
Patient Last Name: CAS

12. Case Abstraction: TCAR
USER: VAM2019
Password: #1registry
Patient Last Name: TCAR

13. Questions