Hybrid repair of tandem high-grade innominate and carotid artery stenosis in an asymptomatic male

Tandem atherosclerotic lesions of the innominate artery (IA) and internal carotid artery (ICA) are challenging and represent an inherent risk of cerebrovascular accidents (CVA). Treating asymptomatic patients is controversial; therefore, it is critical to minimize CVA risk if repair is undertaken. An asymptomatic 78-year-old male with chronically occluded left ICA and tandem stenoses of the IA and right ICA underwent a hybrid intervention with stenting of the IA lesion and right ICA endarterectomy. The intra and postoperative course was successful, without any signs of neurologic sequelae. Sixteen months later, the patient remained asymptomatic, with patent reconstructions.