Hybrid approach in tandem high-grade carotid stenoses: A case report.

A 79-year-old male patient who presented with dizziness and several syncopal episodes was admitted to our clinic. Medical history of the patient revealed arterial hypertension and multifocal atherosclerosis with a history of two ischemic left middle cerebral artery strokes within the last year, without residual deficits, two coronary artery bypass grafts 22 years ago, and Stage IIB peripheral artery disease. The imaging studies revealed severe stenosis of the left internal carotid artery and high-grade ostial stenosis of the left common carotid artery. After clamping of the internal carotid artery and endarterectomy with patch angioplasty, before the patch was completely sutured, a sheath was placed through it and dilation and retrograde stenting of the proximal segment of the left common carotid artery were performed. The neurological symptoms of the patient disappeared and on postoperative computed tomography angiography, there was no residual carotid stenosis.