Technique for transcarotid artery revascularization of tandem lesions

Abstract Repair of tandem carotid lesions have been described in myriad ways, often involving a hybrid approach of stenting with carotid endarterectomy. Due to worrisome stroke rates associated with this method, we report an innovative technique of transcarotid artery revascularization (TCAR) for tandem lesions in a patient with high-grade stenosis of the right common and internal carotid artery. Technical success was achieved with TCAR via retrograde and antegrade access using dynamic flow reversal for treatment of both lesions. The patient had no postoperative complications, showcasing successful repair of tandem carotid lesions with TCAR in a patient high-risk for carotid endarterectomy.