TCAR: Difference between revisions

From Bay Area Structural Heart Wiki
(Created page with "TCAR (TRANSCAROTID ARTERY REVASCULARIZATION) *TCAR supplies kept on a cart in sterile core Med Room 4395B outside Hybrid #14 *Silk Road Rep is present during this procedure* *No Injector * I-Stat & ACT cartridges (Perfusionist room or borrow from IR) Angio pack Micro puncture kit Probe cover Fluoro drape 60cc syringe (for flushing TCAR supplies) Inflation device Contrast syringes (DN) 035 J guide wire (MH) Contrast Standby Supplies: Ku...")
 
No edit summary
Line 40: Line 40:


Contrast tubing (DN)
Contrast tubing (DN)
TCAR essentials
CTA (5 cm CCA, > 6 mm diameter), 0.625 mm cuts 3 days DAPT prior to procedure, or loading >4 hrs
5 days statin prior to procedure, or loading >12 hrs Balloon 3 cm length, 1:1 with healthy distal ICA
Stent 1-2 oversized to CCA/carotid bulb
Contraindication: acute thrombus in the ICA/CCA (life saver sign), long segment disease, swollen ICA, exophytic calcification, >3mm circumferential calcification
start with on-table ultrasound
femoral venous access, and place venous sheath, suture in place
transverse neck incision between two heads of SCM, expose CCA, vessel loop, u-stitch pre-close, access carotid artery, wire, microdilator 2-3 cm into CCA
angiogram, exchange for stiff wire and stop wire short of the CCA, place en-route sheath, assistant ties sheath in two places on the skin, potts the vessel
connect the flow controller, toggle from low to high, fill the tubing while holding it up,, press orange button to stop the flow, connect venous side angiogram
0.014 wire and balloon in place
TCAR timeout
occlude inflow with vessel loops wire cross lesion
generous angioplasty deliver stent
completion angiogram in 2 views release loops to re-establish antegrade flow
disonnect arterial sheath and flow controller and give blood back via venous end remove sheath
protamine
IFU
5 cm from the access to the lesion (previously clavicle to bifurcation)
CCA > 6 mm
ICA 4-9 mm
TCAR is not safe without DAPT
Contralateral occlusion is not a contraindication (10% of TCAR done with occlusion)
About 80% are appropriate for TCAR
SA/Plavix 3 days prior to procedure
urgent, load ASA 650 and Plavix 300, 4 hours before procedure cagrelor 90 mg BID or 180 mg loading

Revision as of 19:53, 6 November 2024

TCAR (TRANSCAROTID ARTERY REVASCULARIZATION)

  • TCAR supplies kept on a cart in sterile core Med Room 4395B outside Hybrid #14
  • Silk Road Rep is present during this procedure*
  • No Injector
  • I-Stat & ACT cartridges (Perfusionist room or borrow from IR)


Angio pack

Micro puncture kit

Probe cover

Fluoro drape

60cc syringe (for flushing TCAR supplies)

Inflation device

Contrast syringes (DN)

035 J guide wire (MH)

Contrast


Standby Supplies:

Kumpe

Bentson guide wire

Amplatz 1cm tip

Contrast tubing (DN)


TCAR essentials CTA (5 cm CCA, > 6 mm diameter), 0.625 mm cuts 3 days DAPT prior to procedure, or loading >4 hrs 5 days statin prior to procedure, or loading >12 hrs Balloon 3 cm length, 1:1 with healthy distal ICA Stent 1-2 oversized to CCA/carotid bulb Contraindication: acute thrombus in the ICA/CCA (life saver sign), long segment disease, swollen ICA, exophytic calcification, >3mm circumferential calcification start with on-table ultrasound femoral venous access, and place venous sheath, suture in place transverse neck incision between two heads of SCM, expose CCA, vessel loop, u-stitch pre-close, access carotid artery, wire, microdilator 2-3 cm into CCA angiogram, exchange for stiff wire and stop wire short of the CCA, place en-route sheath, assistant ties sheath in two places on the skin, potts the vessel connect the flow controller, toggle from low to high, fill the tubing while holding it up,, press orange button to stop the flow, connect venous side angiogram 0.014 wire and balloon in place TCAR timeout occlude inflow with vessel loops wire cross lesion generous angioplasty deliver stent completion angiogram in 2 views release loops to re-establish antegrade flow disonnect arterial sheath and flow controller and give blood back via venous end remove sheath protamine IFU 5 cm from the access to the lesion (previously clavicle to bifurcation) CCA > 6 mm ICA 4-9 mm TCAR is not safe without DAPT Contralateral occlusion is not a contraindication (10% of TCAR done with occlusion) About 80% are appropriate for TCAR SA/Plavix 3 days prior to procedure urgent, load ASA 650 and Plavix 300, 4 hours before procedure cagrelor 90 mg BID or 180 mg loading