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A case series is presented demonstrating a unique approach to the treatment of tandem atherosclerotic lesions of the internal carotid artery. Between 1994 and 1999 eight patients with tandem lesions of the internal carotid artery were treated by combined carotid endarterectomy for the proximal lesion and intraoperative angioplasty of the distal intracranial lesion via the carotid arteriotomy. The success and complication rates were evaluated. A 100% technical success rate was achieved with one post procedural complication by ipsilateral stroke within 24 h. The advantages of this technique include the treatment of tandem lesions by the one procedure, improved transluminal access to the intracranial lesion and the ability to reduce the risk of embolism by flow control during balloon inflation.

Balloon dilation of atherosclerotic arteries is an established procedure with a high success rate and low morbidity. In the past 18 months, 71 patients underwent balloon dilatation at the Royal Melbourne Hospital, with a success rate of 90%. This technique is most successful in short stenoses or occlusions, and earlier investigation of selected patients with intermittent claudication is recommended.