title: Endarterectomy combined with retrograde stenting for tandem lesions of the carotid artery.
abstract: OBJECTIVE
  Due to its location in the chest wall, surgical treatment of lesions at the origin of the brachiocephalic trunk or common carotid artery (CCA) is unattractive. Complete endovascular treatment of lesions at the origin of the common carotid artery or brachiochephalic trunk combined with high-grade lesions at the carotid bifurcation carries a high risk for distal emboli before cerebral protection is installed. Therefore, the combination of open carotid endarterectomy with retrograde stenting of the proximal lesion through one stage is most attractive.
  
  
  METHODS
  Eleven patients were treated with a combined procedure for tandem lesions at the origin of the brachiocephalic trunk or common carotid artery (CCA) and the carotid bifurcation. Endpoint of this evaluation was the 30-day MACE (Major Adverse Cardiovascular Events).
  
  
  RESULTS
  All procedures were finished as planned and no conversion was necessary. Thirty-day mortality was 0%. One patient developed a restenosis after only 4 days for which he underwent a re-PTA procedure. The 30-day MACE was 0%. None of the patients needed additional treatment during follow-up (mean follow-up 33 months; range: 11 to 60) although one patient developed a non-significant stenosis during follow-up.
  
  
  CONCLUSIONS
  Combined treatment of tandem lesions of the carotid artery is safe and effective in the long-term.
authors.affiliation: Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Vermeulen
authors.forename: J M H
authors.initials: JM
authors.lastname: Hendriks
authors.forename: M
authors.initials: M
authors.lastname: Baeten
authors.forename: P
authors.initials: P
authors.lastname: Lauwers
authors.forename: P
authors.initials: P
authors.lastname: Van Schil
mesh_terms: D000368:Aged; D016122:Brachiocephalic Trunk; D017536:Carotid Artery, Common; D016893:Carotid Stenosis / Q000601:surgery*; D057505:Embolic Protection Devices; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015607:Stents