Flow-mediated protection for the treatment of tandem lesions via a transcarotid approach

In patients presenting with both internal carotid and proximal common carotid stenosis, there are many options for repair including open, endovascular, and hybrid approaches. For internal carotid artery lesions, transcarotid artery revascularization (TCAR) has shown an excellent safety profile and allows for a minimally invasive approach. A previous multicenter study assessing the safety of using the same ENROUTE neuroprotection device to treat concurrent proximal lesions of the common carotid artery showed 100% success and 0% stroke or TIA rate within 30 days in the initial sixteen patients. Here we describe the peri‑operative and intra-operative technique to replicate this procedure.