TCAR（transcarotid artery revascularization）の現状と未来

The Current Status and Future of Transcarotid Artery Revascularization

Point

・TCAR（transcarotid artery revascularization）は，総頚動脈を直視下に穿刺しステント留置を行うハイブリッド手術で，本邦への導入が期待されている．

・TCARは頚部頚動脈狭窄症に対する新たな治療選択肢であるが，既存の治療法と比較したハイレベルエビデンスが不足している．

　Transcarotid artery revascularization (TCAR) is a hybrid technique that incorporates features of both carotid endarterectomy (CEA) and carotid artery stenting (CAS). In this procedure, the common carotid artery is directly exposed and punctured under visualization to allow precise stent placement. Since its approval in the United States in 2015, TCAR has become an important treatment option for cervical internal carotid artery stenosis. Although many studies have reported favorable outcomes with TCAR, the overall level of supporting scientific evidence remains limited. CEA is still regarded as the evidence-based standard treatment for carotid artery stenosis, and its significantly lower cost compared with TCAR or CAS is considered another barrier to wider TCAR adoption. Given this background, the introduction of TCAR in Japan—where the clinical outcomes of CAS have been excellent—is of great interest. Moving forward, it will be important to monitor how patient selection criteria and clinical indications for TCAR are defined and how the procedure is ultimately incorporated into routine clinical practice.