A 30-Year-Old Bullet Injury Causing Carotid Stenosis—Simultaneous Carotid Endarterectomy and Off-Pump CABG

This case presents an exceptionally rare and previously unreported combination of intrinsic carotid stenosis and chronic external compression due to a retained ballistic injury. A retained stray bullet injury from 1995 remained untreated for nearly 30 years. In 2025, the patient presented with chest pain. Evaluation revealed 85 percent carotid artery stenosis. The retained bullet separately compressed the carotid bifurcation. The bullet was first carefully extracted from the carotid region. The bullet was deformed and corroded with fibrotic adhesions, indicating chronic tissue reaction. Surgeons then performed a carotid endarterectomy with saphenous vein patch angioplasty. Finally, an off-pump left internal mammary artery to the left anterior descending artery (LIMA-to-LAD) bypass was successfully performed for the 80 percent stenosed left anterior descending artery. The patient had an uneventful recovery and was discharged on postoperative day four.

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