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A 62\u2010year\u2010old 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\u2010making process highlights how tailored approaches can lead to optimal outcomes in complex vascular cases.<\/jats:p>","DOI":"10.1002\/ccr3.70803","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T04:30:41Z","timestamp":1755577841000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The First Report on Strategic Management of Bilateral Carotid Artery Stenosis: Exploring Surgical Challenges and Decision\u2010Making"],"prefix":"10.1002","volume":"13","author":[{"given":"Meghdad","family":"Ghasemi Gorji","sequence":"first","affiliation":[{"name":"Shiraz University of Medical Sciences  Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2293-7628","authenticated-orcid":false,"given":"Yasamin","family":"Bigdeli","sequence":"additional","affiliation":[{"name":"Student Research Committee, Faculty of Medicine Qom University of Medical Sciences  Qom Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5198-5709","authenticated-orcid":false,"given":"Kimia","family":"Jazi","sequence":"additional","affiliation":[{"name":"School of Medicine, Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.25122\/jml-2021-0274"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.09.033"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912321"},{"issue":"2","key":"e_1_2_14_5_1","article-title":"Carotid Artery Stenting Versus Endarterectomy for Treatment of Carotid Artery Stenosis","volume":"2","author":"M\u00fcller M. 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