Transcarotid Artery Revascularization (TCAR): Procedure and Recovery
Updated: 2 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer
Transcarotid artery revascularization (TCAR) is a less invasive way to open a blocked carotid artery in the neck and lower stroke risk. Through a small cut above the collarbone, the surgeon temporarily reverses blood flow away from the brain, then places a stent. It takes about 1.5 hours with an overnight stay.
What the research says
TCAR matched surgery with fewer heart attacks and nerve injuries: a review of 8 studies with about 14,650 people found similar 30-day death and stroke with TCAR and endarterectomy, but heart attack and cranial nerve injury were more likely with endarterectomy (Loufopoulos G et al., Angiology, 2025) [2]
TCAR had lower mortality than stenting through the groin: in 7 studies with 24,246 people with symptomatic carotid disease, TCAR had similar stroke or TIA rates to stenting through the groin but lower mortality; compared with endarterectomy, stroke or TIA was slightly more common (Ghannam M et al., Stroke, 2024) [3]
TCAR and open surgery had the same in-hospital stroke and death rate: in 6,384 matched pairs of patients, in-hospital stroke or death was 1.6% after both TCAR and endarterectomy, and heart attacks were less common after TCAR (0.5% versus 0.9%) (Malas MB et al., Annals of Surgery, 2022) [4]
TCAR beat groin-access stenting on stroke and death: across 13 studies and 142,032 patients, TCAR lowered the 30-day risk of stroke or death (risk ratio 0.57) and of death (risk ratio 0.45) compared with stenting through the groin (Hassan AA et al., Annals of Vascular Surgery, 2026) [5]
Key takeaways
TCAR opens a blocked carotid artery through a small neck incision.
Blood flow is reversed through a filter to protect the brain.
A stent holds the artery open.
It takes about 1.5 hours with an overnight stay.
It has a smaller scar and less nerve damage than endarterectomy.
What is TCAR?
The carotid arteries carry blood to your brain. In carotid artery disease, plaque narrows them. TCAR is one type of carotid revascularization; surgeons perform about 10% of carotid repairs this way. Sources: [1]
Who it's for
It may not suit heavily calcified or very curved arteries.
Older age, heart disease or lung disease.
Neck scar tissue from past surgery or radiation.
A blockage high in the neck that's hard to reach.
Twisted or diseased arteries in the chest that make other stenting harder. Sources: [1]
TCAR may not work well for heavily calcified arteries, blockages in the common carotid artery or very curved arteries. Sources: [1]
TCAR vs. other carotid repairs
They appear to carry similar stroke risk.
Procedure | How it works | Key points |
Plaque removed through a neck incision | Larger scar; more nerve injury | |
Carotid stenting through the groin or arm | Catheter-placed stent | Slightly more minor strokes; fewer heart attacks |
TCAR | Stent through a small neck cut with flow reversal | Small scar; less nerve damage |
Sources: [1, 2, 3]
How to prepare
Blood tests, a carotid ultrasound and a CT angiogram.
Take a statin and antiplatelet medicines as prescribed.
Don't eat or drink after midnight. Sources: [1]
What happens during TCAR
It takes about 1.5 hours.
You get local or general anesthesia.
A tube is placed in a vein in your groin to return filtered blood.
A small incision is made above your collarbone.
The artery is clamped and blood flow is reversed through a filter that catches debris.
A balloon stretches the narrowing, and a stent holds it open.
The tubes are removed and the incision is closed. Sources: [1]
Risks
Injury to the carotid artery.
Bleeding or swelling at the incision.
Nerve damage.
Stroke.
Heart attack.
Rarely, death. Sources: [1, 2, 3]
Recovery
You'll stay in the hospital overnight.
Avoid heavy lifting for a week or more.
Check your incision daily.
Avoid tobacco, exercise regularly and eat foods low in saturated fat.
Take your clot-prevention and cholesterol medicines. Sources: [1]
Outlook
TCAR is newer, so long-term results are still being studied. It appears as safe as endarterectomy or stenting, with excellent outcomes. Sources: [1, 2]
When to call your provider
Fever or chills.
Redness around the wound.
Fluid draining from the wound. Sources: [1]
Call 911 for stroke signs, such as face drooping, arm weakness or trouble speaking.
Conclusion
TCAR offers a gentler way to clear a narrowed carotid artery while protecting your brain from loose plaque. Healthy habits and your medicines help keep the artery open.
Keep learning: read about carotid endarterectomy and carotid artery stenting.
Frequently asked questions
What is TCAR?
A less invasive procedure that stents a blocked carotid artery through the neck.
How does TCAR protect the brain?
Blood flow is reversed through a filter that catches plaque.
Who can have TCAR?
People at high surgical risk and, since 2022, many standard-risk patients.
How big is the incision?
About 1 to 1.5 inches above the collarbone.
How long does it take?
About 1.5 hours.
Will I stay overnight?
Yes, usually one night.
Is TCAR better than endarterectomy?
Stroke risk is similar, with less nerve damage and fewer heart attacks.
When can I lift heavy things?
After a week or more.
What medicines will I take?
A statin and antiplatelet medicines.
Are long-term results known?
TCAR is newer, so long-term data is still growing.
Related Reading
Carotid Endarterectomy: Surgery, Risks and Recovery open plaque removal.
Carotid Artery Stenting: Procedure, Recovery and Results stenting through the groin or arm.
Carotid Artery Disease: The Silent Stroke Risk in Your Neck, Explained the condition TCAR treats.
Transfemoral Carotid Artery Stenting: Procedure, Risks and Recovery stenting through the leg.
References
Cleveland Clinic. Transcarotid Artery Revascularization (TCAR). Cleveland Clinic. Last updated July 20, 2023. https://my.clevelandclinic.org/health/treatments/25150-carotid-revascularization
Loufopoulos G, Manaki V, Tasoudis P, et al. Trans-carotid artery revascularization versus carotid endarterectomy in patients with carotid artery disease: systematic review and meta-analysis of 30-day outcomes. Angiology. 2025;76(10):928-936. PMID 38533833. https://doi.org/10.1177/00033197241241788
Ghannam M, AlMajali M, Khasiyev F, et al. Transcarotid arterial revascularization of symptomatic internal carotid artery disease: a systematic review and study-level meta-analysis. Stroke. 2024;55(4):921-930. PMID 38299350. https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.044246
Malas MB, Dakour-Aridi H, Kashyap VS, et al. TransCarotid revascularization with dynamic flow reversal versus carotid endarterectomy in the Vascular Quality Initiative Surveillance Project. Annals of Surgery. 2022;276(2):398-403. PMID 32941280. https://doi.org/10.1097/SLA.0000000000004496
Hassan AA, Sharaby SA, Elbosraty EE, et al. Comparative safety and efficacy of transcarotid artery revascularization versus transfemoral carotid artery stenting: a systematic review and meta-analysis. Annals of Vascular Surgery. 2026;122:736-754. PMID 40967268. https://doi.org/10.1016/j.avsg.2025.08.052
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own diagnosis and treatment, and seek emergency care right away for severe or sudden symptoms.
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