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Atherosclerotic disease in one arterial site, raise the probability of having other sites affected by about 50% within the vascular axis. Hence once vascular pathology found in one site i.e. coronary artery disease (CAD), other sites i.e. Cerebral and peripheral circulation must be assessed thoroughly, especially in patients with multiple risk factors. Percutaneous intervention (PCI) is a conservative reasonable solution for high risk and inoperable cases; sometimes it supersedes the choice surgery especially with the new era of drug eluting stents (DES) and combined Anti-Ischemic medications. Coronary artery bypass graft (CABG) rather than PCI was the favored cost-effective treatment for complex multivessel coronary artery disease (MVCAD) in the long term [1]. While the evidence base for the cost-effectiveness of DES compared with CABG is growing [1]. Despite the benefits of Coronary Artery Bypass Graft surgery, 15% to 25% of patients develop graft closure within one year following the procedure [2]. Carotid atherosclerotic disease can lead to ischemic stroke or transient ischemic attack (TIA) from embolization, thrombosis, or hemodynamic compromise [3]. Carotid endarterectomy (CEA) was the initial and sole revascularization method for a significant > 70% stenosis [3-12], followed later by introduction of transcatheter Percutaneous angioplasty and stenting [13-20]. For a selected patients with carotid stenosis of 70 to 99 percent, carotid artery stent (CAS) rather than carotid endarterectomy (CEA) is recommended if any of the following conditions are present: A carotid lesion that is not suitable for surgical access, Radiation-induced stenosis, restenosis after CEA, and clinically significant cardiac, pulmonary, or other disease that greatly increases the risk of anesthesia and surgery [13-24]. We hereby present a case of 78-years-old with severe coronary, carotid and peripheral arterial atherosclerosis who showed a successful example of the solution of Hybrid approach of surgical and stenting approach in such cases.

Systemic Atherosclerosis Treated by Hybrid Surgical and Systemic Percutaneous Endovascular Management