In 2016, Silk Road Medical pioneered a novel procedure called transcarotid artery revascularisation (TCAR), which may replace the traditional carotid endarterectomy procedures due to its improved efficacy. Silk Road Medical is the only manufacturer of TCAR devices. This has led to its increased growth in the carotid and renal artery stents (CRAS) market, with an estimated global market share of 6.1% in 2022. Market leaders such as Abbott Laboratories have lost significant market share in CRAS since 2018, according to GlobalData, a leading data and analytics company.

TCAR is a minimally invasive procedure used for treating carotid artery disease. It uses a specialized tube to temporarily reverse blood flow, inhibiting small portions of plaque that may break off from reaching the brain and preventing a stroke from happening. Following this, a soft, flexible stent is placed into the artery to widen it, thus stabilizing plaque build-up and improving blood flow.

Conversely, traditional endarterectomy is an open surgical procedure involving an incision being made into the carotid artery to facilitate the removal of plaque in order to restore normal blood flow. The large incision leaves behind a visible scar and carries risks of surgical complications, including stroke.

Another key difference between TCAR and endarterectomy procedures is that TCAR can be conducted using local anesthesia while endarterectomy requires general anesthesia, which means patients undergoing TCAR may have shorter hospitals stays and faster recoveries.

As a result of its minimally invasive methodology, TCAR reduces the risk of stroke and other complications compared to traditional endarterectomy and results in a shorter recovery time. Given its advantages, TCAR has shown major growth since its first implementation, and may become the primary treatment method for carotid artery disease. While Silk Road Medical still has a relatively small share of the CRAS market compared to large companies such as Abbott and Boston Scientific, its share has steadily grown since the inception of TCAR operations, and the company may one day become the dominant player in this market.