Hybrid Treatment of Tandem Carotid Arterial Stenoses and Contralateral Carotid Occlusion

Purpose: Treatment decisions in complex supraaortic occlusions and stenoses can be challenging. We present a case with tandem carotid arterial stenoses and contralateral carotid occlusion. After intensive interdisciplinary discussion, a hybrid treatment concept was applied.

Materials and Methods: A 72-year-old man sustained a nondisabling right hemispherical stroke caused by acute right internal carotid occlusion. During diagnostic workup, the magnetic resonance angiogram revealed tandem carotid arterial stenoses on the left side with subtotal occlusion at the ostium of the left common carotid artery and subtotal occlusion of the left internal carotid artery at the carotid bifurcation. The patient underwent hybrid treatment in a dedicated hybrid operating room suite by a team of experienced neuroradiologists, interventional radiologists, and vascular surgeons.

Results: Under general anesthesia, the left carotid bifurcation was exposed by the vascular surgeons. Via puncture of the exposed common carotid artery, the left common carotid ostium was treated endovascularly by the radiologists. Then the internal carotid artery was repaired surgically by thromboendartectomy and patch plasty using an intraluminal shunt. No intra- or postoperative complications were observed.

Conclusions: Complex supraaortic stenoses and occlusions can be treated successfully by hybrid procedures combining endovascular and open vascular surgical techniques. Careful planning of the procedure in interdisciplinary discussion is mandatory.