Carotid endarterectomy remains the gold standard treatment for carotid stenosis. Although transfemoral carotid artery stenting is a valid alternative for high-surgical-risk patients, transcarotid artery revascularization (TCAR) has shown promising results. Clinical case: 68-year-old male with hypertension and chronic obstructive pulmonary disease who developed a stroke due to a severe high stenosis in the right internal carotid artery. TCAR was chosen due to the lesion's location and surgical risk. During the procedure, a temporary fistula was created between the carotid artery and the ipsilateral jugular vein to reverse flow as neuroprotection, enabling the safe deployment of the stent. The patient recovered without complications and remains asymptomatic at the one-year follow-up. Conclusion: TCAR is a safe and effective alternative for revascularization in high-risk cases.
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