Transcarotid Arterial Revascularization is Feasible and Safe with Concomitant Inferior Vena Cava Occlusion

Transcarotid artery revascularization (TCAR) has risen as a promising minimally invasive intervention for high risk patients with favorable anatomy. TCAR’s non-inferiority to carotid endarterectomy (CEA) in regards to stroke is reliant on its flow reversal technology and lack of aortic arch manipulation. We present a 79-year-old male with a chronically occluded inferior vena cava (IVC) who safely underwent staged bilateral TCAR for bilateral high grade carotid artery stenosis. Although chronic IVC occlusion alters flow mechanics, we suspect any pressure gradient facilitating retrograde flow from the carotid artery to the femoral vein provides neuroprotective benefits.