Minimally invasive procedure to reduce stroke risk now available locally
Monterey Peninsula resident Brian Pratt made a bit of local medical history on December 11, 2024, as the first person to undergo a transcarotid artery revascularization (TCAR) in a Monterey County hospital.
What's TCAR?
TCAR, an endovascular procedure, opens blocked carotid arteries, reducing stroke risk. TCAR was introduced at Community Hospital of the Monterey Peninsula by Emaad Farooqui, MD, Monterey County’s only board-certified vascular and endovascular surgeon.
The difference between vascular and endovascular surgery
Vascular procedures use open surgery to treat blood vessel conditions while endovascular surgery is minimally invasive with small incisions, which can include benefits like:
- Reduced pain
- Shorter anesthesia time
- Less blood loss
- Faster recovery time
- Fewer complications
Treating blocked carotids with TCAR and CEA
“This procedure is a real gift,” says Pratt, whose carotids were about 95-percent blocked by fatty plaque deposits.
Blocked carotid arteries historically have been treated with open surgery called carotid endarterectomy (CEA). An incision, usually 4 to 5 inches, is made along the neck and then another incision is made in the carotid so the surgeon can remove the plaque. It usually takes about 2.5 hours. With TCAR, a surgeon makes a much smaller incision above the collarbone and places a stent at the blockage site, stabilizing the plaque and creating a clearer path for blood flow, usually in about 45 minutes.
We are so lucky here in a relatively small community to have the medical talent we have. Attracting a talent like Dr. Farooqui and bringing these new technologies and techniques to our little area is such a boon. Montage Health is so good at bringing this stuff in . . . it just seems like on every frontier in health that you can imagine, they are doing it. — Brian Pratt, patient
Pratt has a unique perspective: He had open CEA surgery on his left carotid in May at the same time he underwent a quadruple bypass for coronary artery blockages. By December, TCAR was available at Community Hospital to treat his right carotid.
Done in one of the hospital’s two new hybrid operating rooms, the procedure took less than an hour and Pratt was home the next morning. His recovery in May was more challenging, primarily because of the open-heart surgery and a kidney-related complication. Pratt spent 10 days in intensive care. He also had a complication from the CEA — nerve damage causing temporary partial paralysis of his lower lip.
The nerve damage is one reason Pratt was a good TCAR candidate.
“Once you have a nerve injury on one side, you are at higher risk for the other side,” Farooqui says. “Also, his blockage was higher in the neck, close to the jaw and base of the skull, which is harder to access in open surgery and contributes to nerve injuries.”
Still, CEA is sometimes the preferred approach. The blockage location and the patient’s anatomy, age, surgical risks, and other factors are considered.
“A lot of times patients think minimally invasive is better, but that’s not always the case,” Farooqui says. “Having the ability to offer multiple ways to treat diseases provides the best possible outcomes. We’re able to tailor our approach to the most appropriate procedure.”
Expanding Monterey County's vascular surgery options
Community Hospital has had a strong vascular surgery program for years, says Steven Cabrales, MD, Montage Health’s chief medical officer.
“We have two great physicians, Dr. William Verlenden and Dr. Jon Benner, who practice general surgery and open vascular surgery,” Cabrales says. “And Dr. Jim Joye, a cardiovascular specialist, has been doing some of this work. With Dr. Farooqui, we now have someone who is also trained in the new, less invasive techniques of endovascular surgery.”
Cabrales estimates 80 percent of local people who need vascular or endovascular procedures have been leaving the area to have them done.
“We know that our community wants to stay in the community,” he says, “so we were committed to finding someone who can provide the same level or better care than Stanford or UC San Francisco.”
Farooqui was one of 12 doctors and five advanced practice providers recruited to Montage Medical Group in 2024. The practice now has more than 100 providers in 23 specialties and subspecialties.
“I am very excited to have successfully recruited Dr. Farooqui to be our first and the only endovascular-trained surgeon in Monterey County,” says Mark Carvahlo, MD, CEO of Montage Medical Group. “I am certain this program will quickly grow to meet demand, and I anticipate we will recruit another vascular surgeon to join him in the next one to two years.”
Excellent outcomes mean healthy, happy patients
Pratt was happy to be Farooqui’s first TCAR patient in Monterey County, after researching the procedure and the doctor, who has done about 100 TCARs. He considers himself an informed healthcare consumer. His late father, Russell, was a longtime doctor on the Peninsula, and Pratt is a retired firefighter and medic turned private investigator. He gets his care from a roster of Montage Medical Group doctors: Gregory Cannon, MD, primary care; cardiologist Steven Lome, DO; cardiothoracic surgeon Gregory Spowart, MD; and Farooqui.
“We are so lucky here in a relatively small community to have the medical talent we have,” Pratt says. “Attracting a talent like Dr. Farooqui and bringing these new technologies and techniques to our little area is such a boon. Montage Health is so good at bringing this stuff in . . . it just seems like on every frontier in health that you can imagine, they are doing it.”
Is endovascular surgery right for me?
To decide if you're a candidate for endovascular care, a surgeon will consider:
- Your overall health including illnesses that may make open surgery less compatible
- Your anatomy, such as the size and condition of your blood vessels
- The location of your vascular disease
Conditions that can be treated with vascular and endovascular procedures include:
- Aneurysms (weakened blood vessels)
- Blocked arteries
- Venous disease (e.g., varicose veins) and vein swelling
- Blood clots, stroke risk
- Limb salvage for people with diabetes
- Dialysis access surgery
Learn more about vascular care
