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A 67-year-old man with symptomatic bilateral carotid artery obstructions and a large, friable atheromatous plaque of the transverse aortic arch required coronary artery bypass grafting for severe triple-vessel disease. An endarterectomy of the transverse arch and a left carotid endarterectomy were performed using deep hypothermic circulatory arrest concomitant with quadruple coronary artery bypass grafting. Recovery was uneventful. Hypothermic circulatory arrest provides adequate protection for this combined procedure and may eliminate cerebral embolization.
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