Synchronous endovascular treatment for serial tandem proximal common carotid artery and internal carotid lesions

Purpose : To report simultaneous endovascular repair of tandem proximal common carotid artery and internal carotid artery in a patient with complex post-radiotherapy lesions. Case report : A 67-year-old woman with a medical history of cervical and thoracic radiotherapy and claudication, was admitted with the diagnosis of critical inferior limb ischaemia (stage III-Fontaine) and two recents episodes of amaurosis fugax of the left eye. Duplex Scan and M.R.Angiography revealed high grade stenosis of the proximal left common and internal carotid artery and a complete bilateral iliac artery occlusion. A synchronous ante- and retro-grade carotid endovascular treatment was performed in the first stage of the treatment, allowed by an open minimal cervical access Under cerebral filter protection (Angio-Guard system, Cordis corp.). The post-operative period was uneventful. The patient underwent a successful aortobifemoral reconstruction soon afterwards. At 26 months the patient was asymptomatic. Duplex Scan confirmed a good patency of the carotid stents with normal cerebral CT Scan. Conclusions: Serial common and internal carotid lesions appear amenable to concomitant ante- and retro-grade endovascular repair in selected patients.