Common carotid artery occlusion (CCAO) is a rare condition without standardized treatment, particularly in cases with long, calcified occlusions. We present a 56-year-old man with symptomatic left CCAO (Riles type 1A) treated with a hybrid surgical-endovascular approach due to limited bypass options. Although a guidewire crossed the lesion, device advancement was prevented by dense plaque. Through cervical exposure, the distal wire was grasped and traction applied, allowing balloon angioplasty and stent placement. Complete revascularization was achieved without complications. This case highlights the effectiveness of hybrid strategies for managing complex CCAO with challenging anatomical features.
Uno et al. (2026) studied this question.