TCAR: Surgery clears carotid artery, reduces stroke risk

September 27th, 2019

Gary Hall climbed onto the roof of his home last summer to clean out the gutters on what was a typical, dry 101-degree day in Pueblo, Colorado.

Hall had perched a stepladder on an overhang to reach the gutters near the roofline of his two-story home. Then he passed out.

Gary Hall had TCAR surgery to clear his carotid artery.
Gary Hall had TCAR surgery at UCHealth Memorial Hospital to clear a clogged carotid artery. Photo: UCHealth.

“I blacked out and I didn’t even know I fell. I had no idea. I woke up laying on top of the ladder and that hurt. I was looking up at the sky,’’ Hall said.

His wife, Nancy Hall, thought her diabetic husband had passed out because he had not eaten and was overheated.

A former soldier who had received a Purple Heart after he was wounded in Vietnam, Hall turned to his doctor at the VA Medical Center in Aurora. She ordered a bunch of tests, an EKG, echocardiogram, CT scan and a stress test.

Tests showed that the reason Hall passed out had nothing to do with Pueblo’s hot sun. His left carotid artery was blocked 100 percent; the right side was 55 percent closed. Hall wasn’t getting enough blood to his brain. His doctor at the VA recommended that Hall go see Dr. Magdiel Trinidad-Hernandez, a vascular surgeon at UCHealth Memorial Hospital Central in Colorado Springs and an expert in cleaning out carotid arteries that are clogged with calcium or cholesterol — plaque that can break off, travel to the brain and cause a stroke.

Trinidad-Hernandez proposed a new minimally invasive Trans-Carotid Artery Revascularization (TCAR) surgery for Hall. Essentially, it’s a new method for placing a stent in a carotid artery that reduces the risk of stroke.

Hall’s surgery began with surgical prep followed by anesthesia. Trinidad-Hernandez, the first surgeon in Colorado to do the surgery, then made a one-inch incision at Hall’s neckline, just above the clavicle. He then inserted a tube-shaped device into the carotid artery to temporarily reverse blood flow to protect from plaque coming loose and traveling to the brain. The procedure itself took about an hour.

In the United States, three of every four strokes originates from trouble within the carotid artery, which is about a centimeter in diameter, though the size varies in men and women.

“The carotid artery splits in two at the level between your Adam’s apple and your jaw,’’ Trinidad-Hernandez said. “One goes straight up into your brain and the other one feeds your thyroid, neck and your face. And right there, at that juncture, that’s where the buildup of calcium and cholesterol happen and that’s why if it breaks off there, it is a straight shot to the brain.’’

Gary Hall and his wife, Nancy Hall, in the back yard of their Pueblo home.
Gary Hall and his wife, Nancy Hall, at their Pueblo home. Photo: UCHealth.

Hall spent a day in the hospital, far less time than he did after he was injured in Vietnam in the early 1970s.

“There was a big explosion outside of a bunker; they actually hit the bunker and it blew up and 11,000 rounds of C-4 went off. I hit my head, so it blew and I got a face full of dirt and it burned my eyes and burned my ear off.

“I probably got a scar and I spent three or four days in the field hospital. They couldn’t get us out. Then three or four days later, I remember looking up when they took the bandages off, and I tell you what, I remember looking up and looking up and things were kind of out of focus.

“And finally, I saw the doctor’s eyes and I said, ‘Your eyes are blue.’

Who should have a screening ultrasound?

Dr. Magdiel Trinidad-Hernandez recommends patients over the age of 50 have a screening ultrasound to detect carotid artery disease if:

  • One or both of your parents has had a stroke
  • You smoke or previously smoked
  • Anyone who has coronary or heart disease

Relieved that he could see, Hall returned to the United States. He went on to live throughout the country in Long Beach, California; Denver; Arkansas and Texas and Alaska.

He and his wife, a manager for the Red Cross in Alaska at the time, vacationed all over the world. After one trip to Santiago, Chile, Nancy returned to work in Alaska. Hall went on to Argentina and two weeks later called Nancy: “Honey, I bought a vineyard.’’

He had 50 acres with 25 of them producing grapes for a wine maker. A man who operated the village’s water system lived across the street and helped water the bonarda, shiraz, Malbec and cabernet grapes.

“The water would come down the ditch once a week. For our household water, we’d divert it to a concrete underground cistern and fill it. We’d get 24 hours of water down that ditch every week to water the house and the 25 acres of grapes,’’ he said.

photo of Dr. Trinidad-Hernandez
Dr. Magdiel Trinidad-Hernandez

When Trinidad-Hernandez, the first to do the TCAR surgery in Colorado, talked to him about the importance of proper flow in his carotid, Hall immediately understood.

“The thing with atherosclerosis, which is a fancy word for hardening of the arteries because of buildup of cholesterol or calcium in the blood vessel, is it happens throughout your whole body. If the pipes in your house get rusty, you have rust at the kitchen sink or in the basement, you usually have rusty pipes through the whole house,’’ Trinidad-Hernandez said.

He said that most people who present with carotid artery disease have no symptoms.

“Up to a third of patients, their first symptom is a stroke,’’ Trinidad-Hernandez said. “Carotid artery disease is very easily detected with a screening ultrasound. It takes only a few minutes.’’

Hall said that when he met Trinidad-Hernandez, he immediately was impressed.

Gary Hall, a veteran, photographed in front of an American flag at his Pueblo home.
Gary Hall, a veteran, outside his home in Pueblo. Photo: UCHealth.

“He just seemed to be a step ahead. He walked in and we noticed he was younger than all of our children,’’ Hall said with a chuckle. “Those are the ones who know the latest things, and we had a good connection between UCHealth and the VA.’’

After the operation, Hall said he felt better. He’s back to spending his days having morning coffee with friends and tinkering around the house. He goes fishing on occasion and then heads for the hills to gamble.

“I go up to Cripple Creek every now and then. I win a dollar, lose two,’’ he said.

 

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.