Technical tips for success in transcarotid artery revascularization.

Transcarotid artery revascularization is a minimally invasive technique performed by vascular surgeons for the management of carotid artery stenosis via direct access of the common carotid artery and stenting of the common and internal carotid artery atherosclerotic stenosis. Unlike the transfemoral approach for carotid artery stent angioplasty, the transcarotid artery revascularization procedure allows cerebral protection from embolization without manipulation of the internal carotid artery stenotic lesion via the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Sunnyvale, CA). The ENROUTE reverse flow cerebral protection affords the opportunity to predilate carotid artery lesions with relative impunity before stent deployment. Our technique of transcarotid artery revascularization is detailed in this report of 70 patients (112 procedures) with <1% perioperative neurologic morbidity and documents clinical and hemodynamic (duplex ultrasound testing) success at more than 6 months' follow-up.