New Stroke Prevention Procedure Performed in Australian Hospitals

A surgical procedure known as Transcarotid Artery Revascularisation (TCAR) is now being performed in Australia. The technique, developed in the United States approximately a decade ago, aims to reduce stroke risk by addressing plaque buildup in the carotid arteries. To date, the procedure has been performed on approximately 30 Australian patients across seven hospitals.

Medical Background: The Need for Prevention

Stroke is a leading cause of death and disability in Australia. It often occurs when the blood supply to the brain is interrupted, which can be caused by a buildup of fatty plaque in the carotid arteries—the main blood vessels in the neck supplying the brain.

A standard preventative procedure involves placing a stent inside the affected artery. This is typically done by threading the stent through a catheter inserted via the groin while the patient is awake.

A noted risk of this method is the potential for plaque to be dislodged during the process, which could travel to the brain.

The TCAR Procedure: A Different Approach

The TCAR technique involves a different surgical approach:

• The procedure is performed under general anaesthetic.
• Surgeons make a small incision above the collarbone to access the carotid artery directly.
• A stent is placed through this incision.
• During the operation, a specialized device is used to temporarily reverse blood flow in the artery. Blood is diverted away from the brain and filtered before being returned to the body through a second catheter in the groin.

Proponents of the technique state this flow reversal is designed to capture any debris dislodged during the procedure, thereby protecting the brain. Recovery time is reported to be swift, with patients typically able to sit out of bed within a few hours after surgery.

Regulatory Status and Australian Implementation

The Therapeutic Goods Administration (TGA) has granted special access for the TCAR method to be performed in Australia. The Stroke Foundation is currently reviewing the technique.

Vascular surgeons Dr. Bernie Bourke and Dr. Victor Bourke were the first in Australia to be accredited to perform TCAR. According to the surgeons, their involvement began after being approached by American counterparts familiar with the technique.

Current implementation includes:

• Gosford Hospital, which has performed roughly one-third of all Australian TCAR procedures to date.
• Six other hospitals located in Sydney, Wollongong, Melbourne, and Adelaide, which have performed the remaining cases.
• Dr. Victor Bourke has indicated that Gosford Hospital could serve as a potential site for training other surgeons in the technique.

Perspectives on the New Technique

Medical Perspective:

Dr. Bernie Bourke stated the procedure provides "another tool in our toolbox" for treating patients.

Dr. Victor Bourke described TCAR as a "safer alternative to the current method," adding that it is "reassuring the brain is completely protected" during the operation. The surgeons stated they do not believe the new approach will replace current techniques but that it expands the range of treatment options available.

Patient Perspective:

Lindy Penny, a 71-year-old patient from the Central Coast, underwent the TCAR procedure after tests showed a near-total blockage of her carotid artery. Penny stated she felt she "had nothing to lose" by trying the new procedure. Approximately one month post-surgery, she reported needing only paracetamol for pain relief and noted having more energy and improved breathing.

Advocacy Perspective:

Lisa Murphy, CEO of Stroke Foundation Australia, said, "Any innovation around prevention was a good thing," and that "less invasive ways of doing things are great as well."

International Context

The TCAR technique was developed in the United States approximately ten years ago. According to reports, around 150,000 TCAR procedures have been performed in the U.S. to date.