Simultaneous treatment of symptomatic cervical and tandem intracranial carotid lesions using transcarotid artery revascularization

A 75-year-old man with recurrent hemispheric stroke was found to have severe tandem cervical and intracranial internal carotid artery (ICA) stenoses and a hostile aortic arch. Transcarotid artery revascularization with flow reversal enabled safe carotid access for angioplasty and stenting of the cervical and intracranial ICA through the same access. Imaging confirmed excellent luminal restoration without complications, and follow-up ultrasound study showed <50% residual stenosis of the cervical ICA along with no new neurologic symptoms. This case demonstrates that transcarotid artery revascularization can facilitate single-session multilevel carotid revascularization in high-risk patients, offering a safe strategy when transfemoral access is unfavorable.