The First Report on Strategic Management of Bilateral Carotid Artery Stenosis: Exploring Surgical Challenges and Decision‐Making

Bilateral carotid artery stenosis is a significant risk factor for ischemic stroke, with a prevalence of 8%-39% among stroke patients. This report highlights a challenging case that highlights the complexities of treating bilateral carotid artery stenosis. A 62-year-old male with a history of significant stenosis in the right carotid artery, previously treated with stenting and angioplasty, presented with a transient ischemic attack exhibiting right side symptoms, indicating stenosis on the left side. CT angiography revealed 99% stenosis in the right common and internal carotid arteries and 75% stenosis in the left carotid artery. Given the patient's previous history of stenting, carotid endarterectomy was selected as the optimal treatment choice. Despite challenges including the extensive length of stenosis and the presence of a previous stent, the procedure was successfully completed with restored blood flow. This case emphasizes the importance of individualized surgical planning that considers anatomical and clinical factors in managing bilateral carotid artery stenosis. The decision-making process highlights how tailored approaches can lead to optimal outcomes in complex vascular cases.