Carotid double jeopardy

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Tandem carotid artery stenoses, one at the carotid bifurcation and one more proximal in the common carotid artery or innominate artery, are rare. I suspect that their incidence may increase with the ubiquitous availability of computed tomography angiography. Treatment of these lesions with a hybrid approach with stent placement or angioplasty of the proximal lesion and open endarterectomy of the carotid bifurcation was first reported in 1996.1 A prior meta-analysis showed excellent results.2 More recent reports have urged caution because the stroke and death rate were almost reaching unacceptable levels.