Preventing Strokes, a Safer Way: How TCAR Surgery Compares to Traditional Treatments

Patients with narrowing of the neck’s carotid arteries face an increased risk of stroke. Carotid artery stenosis is caused by atherosclerosis (plaque buildup) that reduces blood flow to the brain. Traditional treatments for carotid artery stenosis have carried significant surgical risks, especially for elderly patients. Now, a minimally invasive technique called Transcarotid Artery Revascularization (TCAR) offers a safer, more effective treatment option.

Led by Dr. Li Xuan, Peking University International Hospital’s Interventional Vascular Surgery Department has successfully performed multiple TCAR procedures, demonstrating the department’s commitment to maintaining world‑class standards in the field. This is due to the fact that Dr. ZHAO Peng, a core member of the team, has recently been credentialed to perform TCAR procedures, making him one of the few specialists in China qualified for this advanced technique.

How TCAR Works to Reverse Blood Flow
TCAR is the "third generation" of carotid artery stenosis treatment, combining the strengths of traditional surgery and endovascular (minimally invasive) intervention.

TCAR Procedure Explained: Through a small incision in the neck, the surgeon directly accesses the carotid artery and establishes a temporary reverse‑flow circuit that diverts blood from the carotid artery to vein in the groin. Any small fragments of plaque that might break loose are safely diverted away from the brain and captured in an external filter during the procedure. This “reverse flow” mechanism dramatically reduces the risk of stroke while surgery is performed.

TCAR Benefits: Compared to conventional carotid endarterectomy (CEA, a surgical removal of plaque) or transfemoralcarotid artery stenting (CAS, where a stent is inserted via the groin), TCAR offers several advantages:

- A smaller incision and faster recovery.

- Lower risk of plaque debris traveling to the brain, because the catheter does not need to pass through the aortic arch—a step that can sometimes dislodge plaque in traditional approaches.

- Particularly suitable for elderly patients, those at high surgical risk, or those with complex anatomy.

Medical Case: 70-Year-Old Surgical Patient
A 70‑year‑old male arrived at Peking University International Hospital with intermittent dizziness that had persisted for two years. CT angiogram revealed critical stenosis (severe narrowing) at the origin of his right internal carotid artery—a condition that carried a high risk of stroke.

The surgical team decided to perform TCAR. Under general anesthesia, Dr. ZHAO Peng made a 3‑cm incision in the neck and implanted a stent. The procedure lasted about one hour, and blood flow was restored to the previously narrowed segment. Six hours after surgery, the patient was already able to walk freely and was highly satisfied with his recovery.

Pre‑operative angiogram showing severe stenosis (left); post‑operative angiogram (right) showing restored flow

Dr. ZHAO Peng and Dr. JIANG Fucheng performing TCAR procedure

Collaborative Success

The successful implementation of TCAR at Peking University International Hospital reflects not only the technical expertise of the Interventional Vascular Surgical Department and Dr. Li Xuan’s team, but also the seamless collaboration with the Anesthesiology Department, the Hybrid Operating Room and the nursing staff. Together, they are providing patients with carotid artery stenosis—especially those who are elderly or at higher risk—with a superior, less invasive treatment option.

Interventional Vascular Surgery Department
Led by Professor Li Xuan, a prominent interventional vascular surgery expert, backbones of the departments are all masters or above, graduated from Peking University Medical Department, Xiangya Medical College and other well-known institutions.

The Interventional Vascular Surgery Department focuses on the diagnosis and treatment of peripheral vascular diseases, cerebrovascular diseases, hemorrhagic emergencies, and portal hypertension. It also specializes in the interventional treatment of benign and malignant tumors and the establishment and maintenance of venous access routes.

Dr. ZHAO Peng
Attending Physician

Professional Summary

Dr. ZHAO Peng is an experienced Attending Physician in the Department of Interventional and Vascular Surgery. Since joining Peking University International Hospital in August 2016, he has developed a specialized focus on the minimally invasive treatment of vascular conditions. He is recognized as one of the early pioneers in China to establish a dedicated varicose vein clinic and to perform ambulatory (no-hospitalization) procedures for this condition. Dr. ZHAO has personally performed nearly a thousand minimally invasive varicose vein surgeries, including individualized approaches such as CHIVA and radiofrequency ablation. His clinical practice spans the full spectrum of interventional vascular treatments, including peripheral artery disease, venous thromboembolism, and complex arterial conditions.

Areas of Expertise

• Minimally invasive treatment for lower extremity varicose veins: One of the first physicians in China to establish a dedicated varicose vein clinic and perform ambulatory (no-hospitalization) surgeries. Has performed nearly a thousand procedures, including individualized approaches such as CHIVA (conservative hemodynamic correction of venous insufficiency) and radiofrequency ablation.
• Endovascular treatment for peripheral artery stenosis or occlusion: Including the renal, iliac, lower extremity, subclavian, carotid, and vertebral arteries, utilizing atherectomy, balloon angioplasty, stent implantation, and pharmacotherapy.
• Minimally invasive thrombectomy and comprehensive management for lower extremity deep vein thrombosis (DVT).
• Interventional surgical treatment for abdominal aortic aneurysms, visceral arterial aneurysms, and pseudoaneurysms.
• Treatment of complications associated with port implantation and PICC placement.
• Interventional treatment for vascular malformations and tumors.

Academic and Professional Positions

• Member, Venous Reflux Disease Group, Chinese Society of Microcirculation
• Member, Chinese Hemangioma and Vascular Malformation Alliance
• Member, Vascular Surgery Committee, Chinese Non-Government Medical Institutions Association