Simultaneous Revascularization Research Articles

Does the presence of coronary artery disease affect the outcome of aortic valve replacement?

The purpose of this study is to compare the late outcome of aortic valve replacement with or without preoperative coronary artery disease, and with or without coronary artery bypass. Between 2014 and 2015, 291 patients underwent aortic valve replacement. Average follow-up term was 2.5±2.2years. The retrospective comparative study was performed between the patients with (n=115) or without (n=176) preoperative coronary artery disease (Study 1) and with (n=93) or without (n=198) coronary artery bypass grafting (Study 2). Study 1: male patients were more, and diabetes was more in the patients with coronary artery disease. Long-term survival rate was significantly low in the patients with coronary artery disease (p=0.0002 by log rank test). Freedom from repeat coronary revascularization rate was lower in the patients with coronary artery disease (p=0.02 by log rank test). Study 2: operation time (419±130 vs 290±101; p=0.0001) was longer in the patients with coronary artery bypass grafting. Improvement of ejection fraction at follow-up was more in the patients with coronary artery bypass(114±43 vs 104±26%; p=0.03). Long-term survival rate and freedom from major adverse cardiac event rater were not different with or without coronary artery bypass grafting (p=0.26 and p=0.59, respectively, by log rank test). Although prevalence of coronary artery disease inversely affected the long-term outcome of the aortic valve replacement, simultaneous coronary artery bypass did not. Aggressive simultaneous coronary revascularization would be important to improve the long-term outcome of aortic valve replacement.

SIMULTANEOUS REVASCULARIZATION OF AORTOFEMORAL AND FEMOROPOPLITEAL ARTERIAL SEGMENTS BY SEMICLOSED LOOP ENDARTERECTOMY

OBJECTIVE. The authors would like to consider the possibility and feasibility of simultaneous revascularization of two arterial segments in patients with lower extremity arterial occlusive disease by method of semiclosed loop endarterectomy. MATERIALS AND METHODS. The research included 143 patients. Revascularization of aortofemoral segment was performed on 67 patients. The simultaneous revascularization of aortofemoral and femoropopliteal segments was carried out for 76 patients. The follow-up period was 5 years. RESULTS. There was revealed that the long-term results of multilevel reconstruction were worse that single-level reconstruction. This method requires an individual approach. The best results of simultaneous interventions were obtained in patients aged 60 and older with the III stage of chronic limb ischemia and 2 or 3 working shin arteries. The worst results were observed in patients younger than 50 year old with IV stage of critical limb ischemia and significant lesions of shin arteries.

Chronic Mesenteric Ischemia: Patient Outcomes Using Open Surgical Revascularization

Background: Chronic mesenteric ischemia (CMI) is a rare disease. Open treatment (OT) remains a valuable treatment option. We analyzed patient outcomes after OT and investigated health-related quality of life (HRQoL). Methods: Data were analyzed retrospectively. The investigation period was from January 1, 2001, to December 31, 2014. We investigated mortality and patency rates using Kaplan-Meier analysis. HRQoL was measured using a 36-item health survey. Various statistical methods were employed. Results: A total of 100 patients (celiac trunk [TC: n = 23], superior mesenteric artery [SMA: n = 26], or both [n = 51]) were included. Median follow-up was 5 ± 35 months. One-year survival rate for TC was 75 ± 11%, for SMA: 79 ± 10%, and for both: 96 ± 3%. TC 5-year survival was 75 ± 11% (SMA: 57 ± 16%: both: 80 ± 8%). Obesity and the length of hospital stay were independently associated with patient survival (p < 0.05). Primary 1-year patency rate was 60 ± 13% for TC (SMA: 86 ± 10%; both: 71 ± 8%) and secondary 1-year patency rate was 84 ± 9% for TC (SMA: 100%; both: 79 ± 7%). HRQoL was inferior compared to the German normative data (p < 0.05). Conclusion: CMI overlaps between gastrointestinal and vascular surgery. OT is safe, and simultaneous revascularization of the TC and the SMA does not affect mortality. Patients would not necessarily benefit from OT in terms of HRQoL.

A Small Sample Retrospective Study of Non-Infarct-Related Artery Simultaneous Revascularization during Primary Percutaneous Coronary Intervention for St-Segment Elevation Myocardial Infarction

Objective: In patients with acute myocardial infarction (AMI) and multivessel coronary disease undergoing primary percutaneous coronary intervention (PCI), we compare the major cardiovascular events and plasma inflammatory markers (hsCRP, sCD40L, IL-6, and TNF-a) after treatment with simultaneous complete revascularization or culprit-only primary angioplasty. Method: From June 2011 to June 2014, a total of 74 patients with AMI and multivessel coronary disease in our hospital underwent primary PCI, and among them 24 (32%) patients underwent simultaneous complete revascularization (complete PCI group) and 50 (68%) patients underwent culprit-only primary angioplasty (culpritonly group), then underwent PCI for the non-infarct-related artery at 1-4 weeks after primary PCI. The outcome was compared between the two groups one year after treatment. Result: There was no significant difference in the incidence of major adverse cardiovascular events (non-fatal myocardial infarction, target vessel repeat revascularization, and cardiac death) between the two groups at one year (P > 0.05). The changes of these inflammatory markers were not statistically significant between the two groups (P > 0.05). Conclusion: Compared to the culprit-only group, the complete PCI group had similar incidences of major adverse cardiovascular events (non-fatal myocardial infarction, target vessel repeat revascularization, all-cause and cardiac mortality). The present study suggests it was safe to intervene the non-infarct-related artery simultaneously during primary PCI. The elevated inflammatory marker levels were reduced in both groups, but the changes of these markers were not significantly different, so the long-term effects of these two PCI procedures are similar.

Off-Pump Coronary Artery and Aortobifemoral Artery Revascularisation: A Combined Approach

Coexistent occlusive disease in the coronary and the aortoiliac arteries has been noted in relatively high incidencewhich affects the management plan. When there is concurrent aortoiliac occlusive disease, most often abdominal aorta is the place of proximal anastomosis for grafting to both lower extremities. However, the ascending aorta may also be used as the source of inflow to both the femoral and coronary arteries in patients who present with coexistent coronary artery disease and aorto iliac occlusive disease. Patients may need to undergo two separate procedures for the same. With this we are reporting a case where off pump coronary artery bypass grafting (OPCABG) was coupled with aortobifemoral artery bypass grafting via ventral extra peritoneal space using bifurcated dacron graft. OPCABG and a simple method of limb bypass procedure is a promising procedure for simultaneous revascularisation of myocardium and lower extremities.

Sequential vs simultaneous revascularization in patients undergoing liver transplantation: A meta-analysis.

We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation. A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the χ(2) and I (2) tests. The risk of publication bias was assessed using a funnel plot and Egger's test, and the risk of bias was assessed using a domain-based assessment tool. A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches. Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (OR = 4.97, 95%CI: 2.45-10.07; P < 0.00001), and intensive care unit (ICU) days were decreased (MD = 2.00, 95%CI: 0.55-3.45; P = 0.007) in the simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group (MD = -25.84, 95%CI: -29.28-22.40; P < 0.00001), there were no significant differences in other outcomes between sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis. The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU.

Simultaneous hybrid revascularization by bilateral carotid stenting and coronary artery bypass grafting

Management of patient with concomitant severe coronary and carotid artery disease is challenging. The combined or staged surgical revascularization is burdened by a high risk of morbidity and mortality. Carotid artery stenting (CAS) has been recently introduced as an alternative revascularization approach. We describe a case of simultaneous hybrid revascularization by CAS followed by immediate coronary artery bypass graft in a patient with a severe coronary artery disease and bilateral carotid artery stenosis.

Simultaneous hybrid peripheral re-vascularization: early results

Endovascular and open surgical interventions may be combined in treatment of peripheral arterial disease. In this study, we presented our simultaneous hybrid peripheral interventions under the light of current literature data. Eleven patients who were operated for occlusive peripheral arterial disease without aneurysms between June 2008 and November 2010 at our hybrid operating room were investigated retrospectively. Generally, endovascular intervention was performed initially, and then followed by surgery. After hybrid interventions, control angiograms were held during the same session. None of the patients experienced either stent or graft occlusion during early postoperative period. Primary patency rate was found to be 100% for the postoperative first six months. Ankle-brachial indices (ABI) increased significantly during postoperative period and clinical symptoms were relieved in all patients (mean preoperative ABI: 0.43 ± 0.08, mean postoperative sixth month ABI: 0.87 ± 0.08). Peripheral hybrid interventions may be performed both in separate sessions and also simultaneously by experienced teams if an angiography device is available within the operating room.

Robotically Assisted Hybrid Coronary Revascularization: Does Sequence of Intervention Matter?

Hybrid coronary revascularization (HCR) is a treatment strategy for the revascularization of multivessel coronary disease that combines the advantages of both minimally invasive surgical techniques and percutaneous coronary intervention (PCI). The optimal sequence by which revascularization should be accomplished has not been determined. We investigated clinical outcomes in a series of patients planned for HCR via robotically assisted totally endoscopic coronary artery bypass (TECAB) and standard PCI based on revascularization sequence. A total of 238 patients planned for HCR between 2001 and 2011 were divided into three groups based on treatment sequence: (a) TECAB before PCI, (b) PCI before TECAB, and (c) same-session procedure. Multiple procedural and clinical end points before discharge and up to 2 years after the procedure were compared between the three groups in an intention-to-treat analysis. Demographic features were reviewed to determine baseline differences between each group. Of the 238 patients, 175 (73.5%) underwent TECAB before PCI, 38 patients (16.0%) underwent PCI before TECAB, and 25 (10.5%) underwent a simultaneous revascularization procedure. At baseline, the patients undergoing TECAB before PCI were significantly older. There was a significantly higher incidence of previous myocardial infarction in the PCI-first group (P < 0.001). There was a significant difference in intensive care unit (ICU) length of stay (LOS), with shorter ICU stays in the simultaneous revascularization group (P = 0.031) and shorter hospital LOS in the PCI before TECAB group (P = 0.021). In conclusion, revascularization sequence did not dramatically impact clinical outcomes in our observational study. The patients undergoing PCI-first and same-session interventions had shorter hospital and ICU LOS compared with the patients undergoing surgery first. Our findings suggest that no revascularization approach is arbitrarily superior and that revascularization sequence should be individualized on the basis of patient presentation and anatomical considerations.

Midterm Outcomes of Simultaneous Hybrid Coronary Artery Revascularization for Left Main Coronary Artery Disease

The purpose of this study was to evaluate the feasibility, safety, and midterm outcomes of a simultaneous hybrid revascularization strategy for left main coronary artery disease (LMCAD), compared with conventional off-pump coronary artery bypass grafting (OPCAB). We compared the in-hospital and midterm outcomes of a simultaneous hybrid revascularization strategy (minimally invasive direct coronary bypass grafting of the left anterior descending coronary artery [LAD] and percutaneous intervention to non-LAD lesions) in 20 patients with LMCAD in an enhanced operating room. These patients were matched by propensity score to a group of 20 control patients who underwent standard OPCAB between September 2007 and December 2009. All baseline clinical characteristics of the 2 groups were similar. All of the patients in the 2 groups underwent surgery uneventfully without conversion to on-pump coronary artery bypass grafting. Compared with OPCAB, the patients in the hybrid group had shorter lengths of stay in the intensive care unit (34.8 ± 37.6 hours versus 50.7 ± 34.5 hours, P = .01). Transfusion requirements were reduced in the hybrid patients compared with the OPCAB patients (5% versus 40%, P = .01). The 2 groups did not differ with respect to the occurrence of other important morbidities. During the mean (±SD) follow-up of 18.5 ± 9.8 months, the group of patients who underwent the simultaneous hybrid procedure experienced an incidence of major adverse cardiac or cerebrovascular events that was similar to that of the OPCAB control group (100% versus 90%, respectively; P = .31). The midterm follow-up indicated that the simultaneous hybrid revascularization procedure for LMCAD is feasible, safe, and effective. These promising early findings warrant further prospective investigations.

Simultaneous carotid endarterectomy and myocardial revascularization by using cardiopulmonary bypass for both procedures

Simultaneous carotid endarterectomy and myocardial revascularization by using cardiopulmonary bypass for both procedures

Diagnosis and management of fibromuscular dysplasia: an expert consensus

Diagnosis and management of fibromuscular dysplasia: an expert consensus

Safety and feasibility of complete simultaneous revascularization during primary PCI in patients with STEMI and multi-vessel disease

Contemporary guidelines recommend to dilate only the infarct-related-artery (culprit only revascularization) during the initial procedure in patients with STEMI and multi-vessel disease treated with 1ry PCI, leaving the other stenosed vessels untreated to be dilated during a second elective procedure (staged revascularization). Recently, with the advent of time, experience, expertise, and technique the multi-vessel PCI procedure became more reliable, predictable, and reproducible. We therefore believe that it was reasonable in our study to reinvestigate the clinical outcomes of complete revascularization strategy during the index procedure in patients with STEMI and multi-vessel disease. A total of 78 patients (72 males and 6 females) with ST-elevation MI presented within 12 h from the onset of symptom who had at least two angiographically-documented diseased coronary arteries (luminal diameter narrowing ⩾70%) and received primary PCI were included. They were randomly assigned to receive either PCI for culprit vessel only in the initial procedure (SR group) followed by another session of angioplasty to other diseased vessels (within 7 days), or (CR group) consisted of 42 patients who had received complete revascularization during the initial procedure after intracoronary administration of nitroglycerin to avoid stenting of functionally non-significant lesions. The combined incidence of MACE including death, recurrent myocardial infarction, re-hospitalization for angina and cerebrovascular accidents during 1 year follow up was recorded. The baseline characteristics were well balanced between the study groups with the angiographic and procedural data showed no significant difference. The study end point combining death, MI, readmission because of recurrent ischemia or cerebrovascular accidents at 1-year follow-up occurred in 19.4% of patients with the complete staged strategy and 26.2% of patients with the complete simultaneous strategy ( P = 0.5). A simultaneous multi-vessel strategy during primary PCI is safe and feasible with no clear long term benefits in MACE rates over staged multi-vessel strategy. These data suggest that the decision to perform a simultaneous complete revascularization or to limit the procedure to culprit vessel only followed by elective intervention of the non-culprit vessels in patients with AMI and multi-vessel disease remains a decision to be made by individual operators and patients.

Invited commentary

This single-center study is another piece of evidence in a growing wave of reports addressing important clinical outcomes after endovascular treatment of thoracic aortic pathology. In Table III, the authors specifically segregate outcomes in patients who did and did not have left subclavian artery revascularization, and the comparisons are striking, with a 28% risk of combined stroke, paraplegia, or death when the left subclavian artery was not revascularized compared with none when it was revascularized. Their analysis may be confounded by the nonrandomized design in which they more recently have routinely performed the subclavian revascularization, and they have certainly improved other components of their institutional systems. Further confounding may occur with emergency cases, when staged or simultaneous revascularization may not be possible. Taken together with other reports, these institutional experiences from centers of excellence with thoracic endovascular aortic repair are painting an impressive picture. In a recent meta-analysis of 51 eligible studies, sponsored by the Society for Vascular Surgery, the Mayo Clinic Knowledge and Encounter Research Unit found risks increased by odds ratios of 47.7 for arm ischemia, 10.8 for vertebrobasilar ischemia, 2.69 for spinal cord ischemia, and 2.58 for anterior circulation stroke with left subclavian coverage without revascularization compared with revascularization.1Rizvi A.Z. Murad M.H. Fairman R.M. Erwin P.J. Montori V.M. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis.J Vasc Surg. 2009; 50: 1159-1169Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar The clinical practice guidelines of the Society for Vascular Surgery “suggest” routine preoperative revascularization when the left subclavian artery is covered. They provide a stronger “recommend” routine revascularization in circumstances where collateral perfusion may be compromised.2Matsumura J.S. Lee W.A. Mitchell R.S. Farber M.A. Murad M.H. Lumsden A.B. et al.Management of the left subclavian artery with TEVAR: clinical practice guidelines of the Society for Vascular Surgery.J Vasc Surg. 2009; 50: 1155-1158Abstract Full Text Full Text PDF PubMed Scopus (304) Google Scholar Unfortunately, the evidence supporting these recommendations is very low quality, and there are no randomized data that provide stronger evidence for decisions being made today. It is not surprising there are worse outcomes with occlusion of a major aortic arch vessel compared with strategies that maintain antegrade flow in the left subclavian artery. Vertebral, internal thoracic, and thoracodorsal arteries can be major contributors of brain and spinal cord collateral blood flow. This St. George's Vascular Institute report is another contribution to the evidence favoring revascularization of the left subclavian artery. Outcomes of the endovascular management of aortic arch aneurysm: Implications for management of the left subclavian arteryJournal of Vascular SurgeryVol. 51Issue 6PreviewThis study was conducted to define the outcomes of treating aortic aneurysms involving the arch vessels with a hybrid approach using extra-anatomic reconstruction and endovascular repair with nonfenestrated stents. Full-Text PDF Open Archive

Surgical Treatment of Saphenous Vein Graft Aneurysms After Coronary Artery Revascularization

Saphenous vein graft (SVG) aneurysms (SVGAs) after coronary artery bypass grafting (CABG) occur rarely. Most reports are anecdotal. To determine early and late outcomes of surgical treatment, we reviewed our experience with management of this rare complication of surgical revascularization. From July 1975 to October 2007, 16 patients (15 men), mean age, 60.9 +/- 14.6 years, underwent repair of aortocoronary SVGAs. Chest pain was present in 11 of 16 patients. The rest were asymptomatic. The average maximum diameter of the SVGA was 64 +/- 30 mm. The concern of SVGA rupture was the primary indication for operation in 9 patients (56%). Repair in the remaining patients occurred during other cardiac operations. A pseudoaneurysm (75%) at the body or anastomotic sites of the SVG was the most common cause of SVGA. In 8 patients (50%), the aneurysm involved SVG anastomotic sites. Thirteen patients (81%) had intraluminal thrombi. Vein grafts with aneurysm were patent in 9 patients (56%). Surgical procedures included excision of the aneurysm and direct distal coronary target vessel revascularization in 10 (63%), excision and interposition vein graft in 5 (31%), and exclusion by ligation in 1 (6%). Median follow-up was 7 years (maximum, 20 years). Survival was 83% at 5 years and 72% at 10 years after SVGA repair. Ischemic symptoms often accompany SVGA, and operation is indicated to prevent rupture. Ligation or excision of SVGA with simultaneous revascularization appears to be the optimal therapy, with satisfactory midterm and long-term results.

Combined coronary and femoral revascularization for the treatment of hypoplastic aortoiliac syndrome: Report of a case

The coronary artery and aortoiliac occlusive disease frequently coexist and in relatively rare instances, a complication of hypoplastic aortoiliac syndrome (HAIS) may occur. We herein present our experience with a 51-year-old female patient with HAIS and concomitant coronary artery disease. She underwent a successful simultaneous coronary and femoral revascularization. The left anterior descending artery was bypassed with the in situ gastroepiploic artery and a biaorto-external iliac artery bypass was performed with expanded polytetrafluoroethylene precuffed grafts. She had a good postoperative course, with no angina or intermittent claudication. The importance of the technical aspects of reconstructive surgery in patients with HAIS has been emphasized in many reports in the literature, and the surgical options for combined coronary and femoral revascularization are also discussed herein.

Simultaneous Revascularization and Coverage of a Complex Volar Hand Blast Injury: Case Report Using a Contralateral Radial Forearm Flow-through Flap

War wounds have created a unique reconstructive challenge for successful functional limb salvage. Various injury patterns related to improvised explosive devices (IEDs) occur and proper reconstruction goes a long way in reducing subsequent disfigurement and morbidity. One case in which a contralateral radial forearm flow-through flap is used for simultaneous revascularization and coverage of an IED hand blast injury is described. The advantages of this flap was its consistent arterial anatomy and long vascular pedicle. The thin skin paddle was used for soft tissue coverage of flexor tendon repair, median and ulnar nerve reconstruction, and metacarpal bone open reduction and internal fixation (ORIF). Recovery of motor function was satisfactory.

Damage Control Resuscitation for Vascular Surgery in a Combat Support Hospital

Hemorrhage from extremity wounds is a leading cause of potentially preventable death during modern combat operations. Optimal management involves rapid hemostasis and reversal of metabolic derangements utilizing damage control principles. The traditional practice of damage control surgery favors a life over limb approach and discourages elaborate, prolonged vascular reconstructions. We hypothesized that limb preservation could be successful when the damage control approach combines advanced resuscitative strategies and modern vascular techniques. Trauma Registry records at a Combat Support Hospital from April to June 2006 were retrospectively reviewed. Patients with life-threatening hemorrhage (defined as >4 units of packed red blood cells) who underwent simultaneous revascularization for a pulseless extremity were included. Data collection included the initial physiologic parameters in the emergency department (ED), total and 24-hour blood product requirements, and admission physiology and laboratory values in the intensive care unit (ICU). Outcome measures were survival, graft patency, and amputation rate at 7 days. Sixteen patients underwent 20 vascular reconstructions for upper (3) or lower extremity (17) wounds. Patients were hypotensive (blood pressure 105/60 +/- 29/18), acidotic (pH 7.27 +/- 0.1; BD -7.50 +/- 5.5), and coagulopathic (international normalized ratio 1.3 +/- 0.4) on arrival to the ED and essentially normal upon admission to the ICU, 4 hours later. Vein grafts (19/20, 95%) were used preferentially. Prosthetic grafts (1), shunting and delayed repair (4) or amputation (1) were infrequent. Heparin was not used or limited to a half dose (5/20, 25%). Tourniquets (12/16, 75%) and fasciotomies (13/16, 81%) were routine. Most (75%) received recombinant factor VIIa in the ED and in the operating room. All survived with normalized physiology on arrival in the ICU. Twenty-four-hour crystalloid use averaged 7.1 +/- 3.2 L, whereas packed red blood cells averaged 23 +/- 18 units, and 88% were massively transfused. Median operative time was 4.5 hours (range, 1.7-8.4 hours). Aggressive damage control resuscitation maneuvers in critically injured casualties successfully permitted prolonged, complex extremity revascularization with excellent early limb salvage and graft patency. Recombinant VIIa and liberal resuscitation with fresh whole blood, plasma, platelets and cryoprecipitate, while minimizing crystalloid, allowed limb salvage and did not result in early graft failures.

Functional outcome after femoral endarterectomy: A single-centre experience

To assess limb salvage and functional outcome in patients who underwent femoral endarterectomy (FE). A single-centre, retrospective analysis of all patients undergoing FE in the past four years. FE was performed on 30 patients (32 symptomatic legs) to treat gangrene (n=5), pain at rest (n=7) and incapacitating intermittent claudication (n=20). Patients had a mean age of 76.2 years. Twenty-three FEs were performed electively and nine were emergency procedures. Twenty-two patients were operated on under general anesthesia, five under local anesthesia and three under spinal/epidural anesthesia. Forty-six per cent of the patients underwent a simultaneous revascularization procedure (33% profundaplasty, 3% femoral-femoral cross-over, 3% femoral-popliteal and 3% aorto-bifemoral bypass). Overall patency rate and limb salvage rate was 80% and 74%, respectively, at mean follow-up of 25 months. Early mortality was 6% and morbidity was 24%. Among the living patients, 88% were happy with their quality of life and rated the procedure excellent, 6% rated the procedure as good and 6% rated the procedure as bad. The functional outcome of FE is very favourable, either as a primary or adjunctive procedure where angioplasty is not possible. FE can be performed under locoregional anesthesia, which is potentially suitable in elderly patients to avoid major amputation and its associated sequelae.

Concomitant Multiple Revascularizations in Supra-Aortic Arteries: Short-Term Results in 50 Patients

The outcome for simultaneous revascularization of more than 1 supra-aortic arterial stenosis has not been evaluated because of concerns regarding the increased risk of additional procedures. We evaluated the feasibility and safety of concomitant multiple supra-aortic arterial revascularizations (CMSAR). We retrospectively evaluated 50 consecutive patients who underwent CMSARs with angioplasty and stent placement. The study included a separate lesion group (LG) (n = 28), ipsilateral LG (n = 17) including adjacent (n = 6) and remote (n = 11) tandem lesions, and triple LG (n = 5). We assessed the procedural success (defined as residual stenosis <30%) and periprocedural event rate (ER) (minor or major stroke, and death). We compared the ERs in the lesion (ipsilateral vs separate) and symptom (unstable vs stable) pattern groups with the Fisher exact test. Procedural success was achieved in all patients (50/50). Periprocedural events within 30 days were noted in 5 (10%). ER within 2 days after the procedure was higher in the ipsilateral LG (4/17) than in the separate LG (0/28) (P = .016). Major events consisting of a major stroke and a death occurred in 2 patients in the unstable group (4%) and was more common in the unstable (2 of 7) than in the stable group (0/38) (P = .029). During the mean 11-month follow-up period, there was 1 symptomatic recurrence. CMSARs are feasible with a high procedural success rate resulting in a favorable short-term outcome. However, they must be carefully performed in ipsilateral LG, especially in patients in the unstable group.