<s>[INST] what procedure is recommended for a 79 year old patient with 75% blockage in Right carotid artery and 95% blockage in left carotid artery who also has congestive heart failure and irregular heartbeat? Yesterday during procedure it was discovered a stint was impossible to place because patient has a bovine arc in his heart area [/INST] Hello! Thank you for asking on Chat Doctor! Facing the actual clinical situation, a surgical carotid endarterectomy procedure would be the most appropriate choice. A comprehensive preoperative evaluation should be performed (including cardiology consult, anesthesiology consult, and vascular surgeon consult), to conclude about the potential risks and benefits derived by the proposed strategy. Hope to have been helpful to you. Greetings!  </s>