This study states that the Transcarotid artery revascularization (TCAR) using the ENROUTE Transcarotid Neuroprotection and Stent System (Silk Road Medical, Sunnyvale, Calif) is a hybrid technique with excellent initial outcomes. The technical success of TCAR is heavily dependent on an anatomically suitable common carotid artery (CCA). Many patients do not meet the anatomic criteria for TCAR and are not eligible for this therapy. We sought to extend the eligibility of TCAR to patients with unfavorable CCA anatomy by the adoption of a prosthetic arterial conduit.

Patient 1, a 57-year-old man, presented with recurrent >90% internal carotid artery (ICA) stenosis after carotid endarterectomy for symptomatic disease. Arteriography demonstrated severe stenosis of the ICA and diffuse CCA atherosclerosis (Fig, A). The CCA was replaced with a 6-mm polytetrafluoroethylene interposition graft incorporating a side arm limb for stent deployment (Fig, B-D). Patient 2 was a 62-year-old man with prior neck irradiation and asymptomatic >90% stenosis of the distal CCA. Computed tomography angiography showed a <5-cm distance from clavicle to carotid lesion. We performed TCAR by a 6-mm Dacron conduit sewn to the CCA. Patient 3 was an 80-year-old woman with recurrent symptomatic >80% ICA stenosis. TCAR was performed in the same manner as in patient 2, secondary to short distance. 


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