title: Hybrid Interventions in the Case of Combined Stenosis of the Carotid Bifurcations and Supra-Aortic Arteries.
abstract: OBJECTIVE
  The purpose of our study is to describe the technique, safety, and efficacy of hybrid carotid revascularization for the treatment of combined occlusive lesions of the carotid bifurcations and supra-aortic arteries.
  
  
  METHODS
  We monitored the results of hybrid surgical interventions including carotid endarterectomy (CEA) and stenting either the common carotid artery (CCA) or the brachiocephalic trunk (BCT) in 12 patients. Nine men and 3 women with occlusive atherosclerosis made up the cohort. All surgical interventions were performed with local anesthesia by means of standard operative access to the bifurcation of the carotid artery. After the correction of the proximal stenosis of the CCA or BCT with subsequent angiography, the CEA was performed. The mean follow-up was 33.5 months (range, 6-48).
  
  
  RESULTS
  Ten patients underwent left CCA stenting in combination with CEA. Among the 10 patients, CEA was performed using the eversion technique in 5 cases and patch angioplasty in the other 5 cases. In the remaining 2 cases, the patients underwent CEA with patch angioplasty of the right internal carotid artery in combination with stenting of the BCT critical stenosis. During the early postoperative period and follow-up to 48 months, a stroke was not registered.
  
  
  CONCLUSIONS
  Hybrid interventions (CEA and stenting of the CCA or BCT) allow combination of the advantages of each method in the treatment of multilevel vascular disease. This study confirms the safety and efficacy of hybrid interventions in a small cohort of patients while emphasizing the need for future randomized controlled trials in larger populations.
authors.affiliation: Novosibirsk Research Institute of Circulation Pathology Named by Meshalkin, Novosibirsk, Russian Federation. Electronic address: starodub@mail.ru.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Starodubtsev
authors.affiliation: Novosibirsk Research Institute of Circulation Pathology Named by Meshalkin, Novosibirsk, Russian Federation.
authors.forename: Andrey
authors.initials: A
authors.lastname: Karpenko
authors.affiliation: Novosibirsk Research Institute of Circulation Pathology Named by Meshalkin, Novosibirsk, Russian Federation.
authors.forename: Pavel
authors.initials: P
authors.lastname: Ignatenko
mesh_terms: D000368:Aged; D017130:Angioplasty; D001013:Aorta, Thoracic / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery* / Q000628:therapy; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011446:Prospective Studies; D019736:Prostheses and Implants; D015607:Stents; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates
keywords: Carotid artery; carotid bifurcations; carotid endarterectomy; hybrid procedure; supra-aortic arteries; tandem lesions