title: Feasibility and Safety of Simultaneous Carotid Endarterectomy and Carotid Stenting for Bilateral Carotid Stenosis: A Single-Center Experience using a Hybrid Procedure.
abstract: BACKGROUND
  The treatment for bilateral carotid stenosis (BCS) is challenging, and the optimal treatment strategy is not clear. We report our experience of treating 8 patients with BCS by simultaneous carotid endarterectomy (CEA) and carotid stenting (CAS), thereby providing an alternative for vascular surgeons.
  
  
  METHODS
  Between October 2010 and August 2014, 8 patients (5 males and 3 females; range, 53-82 years; mean, 69 ± 8.8 years) underwent simultaneous CEA and CAS in our hospital. CEA before CAS was done in 5 patients, and CAS before CEA was done in 3 patients. One patient also underwent simultaneous coronary artery bypass grafting due to unstable angina. Intraoperative transcranial Doppler ultrasonography, carotid shunts, patches, and embolic protection devices were used in all patients. Instances of hyperperfusion syndrome (HPS), hemodynamic depression, stroke, myocardial infarction (MI), and death were recorded.
  
  
  RESULTS
  All patients completed the procedure. One patient developed postprocedural HPS. After systemic treatment, he recovered completely. There were no deaths, major and/or minor strokes, or MI, nor did any patient exhibit lower palsy in cranial nerves in the perioperative period (<30 days) or on clinical follow-up (3 and 6 months). We observed no restenosis and no recurrent symptoms during follow-up.
  
  
  CONCLUSIONS
  After careful preoperative assessment and preparation, simultaneous CEA and CAS for high-grade BCS may be considered as an alternative management strategy in carefully selected patients.
authors.affiliation: Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Rong-Wei
authors.initials: RW
authors.lastname: Xu
authors.affiliation: Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Xue-Qiang
authors.initials: XQ
authors.lastname: Fan
authors.affiliation: Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Jian-Bin
authors.initials: JB
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China. Electronic address: yezhidong2014@163.com.
authors.forename: Zhi-Dong
authors.initials: ZD
authors.lastname: Ye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D002681:China; D003131:Combined Modality Therapy; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial