MarinHealth introduces new carotid artery procedure to prevent stroke

Jim Williams of Novato was suffering from severe carotid artery stenosis, meaning the artery walls in his neck were blocked with plaque, increasing his risk of stroke.

Williams, who turned 76 on Saturday, previously experienced a transient ischemic attack, or ministroke, so traditional open surgery was not ideal because of the high risk for complications involved.

His vascular surgeon, Dr. Allan Conway at MarinHealth Medical Center, had the solution: a new, minimally invasive procedure called transcarotid artery revascularization. The procedure was successfully completed on Thursday, making the Greenbrae hospital the first in Marin County to accomplish the task.

"We are extremely grateful to Dr. Conway and his talented team for bringing this highly innovative and lifesaving procedure to MarinHealth and the community at large," Dr. David Klein, chief executive officer of MarinHealth said in a statement.

"Once again, MarinHealth stands at the forefront of clinical excellence, providing our patient populace with the most cutting-edge procedures," he said.

Conway, a vascular surgeon at Lenox Hill Hospital in New York City for 10 years who served as an associate professor of surgery and program director of the vascular surgery residency, joined MarinHealth in November.

Transcarotid artery revascularization, or TCAR, is a 45-minute procedure that involves a surgeon slicing a small incision in the neck.

Conway said this allows him direct access to the carotid artery so he could place a stent inside to stabilize the plaque. The technique also involves connecting the carotid artery to a system that redirects blood flow, so that loose plaque does not drift upstream to the brain during the procedure.

"What's most exciting for me is what it enables us to do in Marin," Conway said. "Now we can treat carotid artery disease with all approaches.

"My impression is that the outcomes are so good," he said, "that in the next few years we will see that rise." He said "it's less invasive and the outcomes match the gold standard."

The gold standard has been the open surgery method called carotid artery endarterectomy, Conway said. The procedure involves the surgeon making a larger incision, which could produce more visible scarring; it takes about two hours to perform and it requires an average of three days in a hospital bed for recovery.

One of the problems is, for high-risk patients, the procedure itself could induce a stroke, Conway said. In addition to being lower risk and less invasive, the TCAR method is quicker to perform, and the average patient is released from the hospital after one night, Conway said.

MarinHealth performs about 70 to 80 carotid artery surgeries a year, Conway said. He expects that at the start, about 20% of future procedures at the Greenbrae hospital will be done using the TCAR method.