A case of tandem lesions in the extracranial internal carotid artery

The tortuous internal carotid artery is occasionally encountered during carotid endarterectomy. While much has been written about the hemodynamic problems associated with the tortuous vessel, a second atherosclerotic plaque in the kinked portion of the artery has not been reported previously, to our knowledge. We encountered such a case, with the second lesion recognized at reexploration following neurologic deficit after a standard carotid endarterectomy. The presence of a solitary lesion at the carotid bifurcation should not be assumed.