ObjectiveTo evaluate the safety, efficacy, and advantages of transcarotid artery revascularization (TCAR) in patients with high-risk carotid artery stenosis. MethodsThe patient was a 76-year-old male with severe symptomatic stenosis of the right internal carotid artery, complicated by multiple high-risk factors (such as cardiac insufficiency, history of coronary stent implantation, aortic calcification). Given his unsuitability for carotid endarterectomy and the high perioperative risk associated with transfemoral carotid artery stenting, TCAR was performed. The procedure involved puncturing the common carotid artery via a small cervical incision to establish a temporary carotid-to-femoral venous reversed-flow pathway. Following balloon predilation, a stent was deployed, and the reversed-flow system was used to divert potential plaque debris outward, thereby reducing the risk of intraoperative cerebral embolism. ResultsThe procedure was completed successfully. The operation time was approximately 70 min, the estimated blood loss was 20 mL. Postoperatively, the patient did not experience complications such as stroke, neurological deficit, or hyperperfusion syndrome. Although carotid sinus reflex-induced hypotension occurred, which stabilized after pharmacological management. The results of following-up at 3 months showed the stent was patent with no evidence of in-stent restenosis. ConclusionsThe findings of this case indicate that TCAR combines the cerebral protection advantages of carotid endarterectomy with the minimally invasive features of transfemoral carotid artery stenting. Its reversed-flow mechanism helps effectively prevent intraoperative embolism, offering a safe and viable revascularization option for patients with high-risk carotid artery stenosis.
