Surgery and stenting as combined treatment of a symptomatic tandem stenosis of the carotid artery

International co-operative studies have demonstrated a benefit from surgery for symptomatic and asymptomatic patients affected by internal carotid art ery stenosis of 60-70%. The presence of a tandem lesion, intracranial or ex tracranial, may annul the benefit of surgery. Such patients may thus repres ent a challenging problem for management if age, good general conditions an d a normal neurological status favour a therapy. A 54-year-old man develope d transient ischaemic attacks of the left hemisphere; his general condition was good, and neurological status was normal. Angiography showed a tight s tenosis at the left common carotid artery near the ostium and at the homola teral carotid bifurcation. At first, a serf-expanding wall stent was placed at the level of the common carotid artery stenosis, and immediately after a standard endarterectomy under general anaesthesia was performed. The post operative course was normal and was complicated only by the presence of a m ild deficit of the hypoglossal nerve due to the presence of a high bifurcat ion. The early and late outcome of our case suggests that stenosis of the p roximal common carotid artery may be successfully treated by stenting. Whil e awaiting additional data about this new technology, endovascular techniqu es and surgery may be complementary in the management of patients suffering from such tandem lesions.