Clinical outcome after endovascular, surgical or hybrid revascularisation in patients with combined carotid and coronary artery disease: the Finalised Research In ENDovascular Strategies Study Group (FRIENDS).

AIMS: To assess the 30-day clinical outcome of endovascular and surgical revascularisation procedures in patients with carotid obstructive disease (COD) and concomitant coronary artery disease (CAD). METHODS AND
RESULTS: Between January 2006 and December 2009, 659 patients with COD and concomitant CAD were treated. The incidence of the primary endpoint (composite of death, MI and stroke) was 4.25% (0.9%, 1.1% and 2.3%, respectively). Acute renal insufficiency occurred in 2.4% and major bleedings in 4.4% of patients. According to the treatment forms patients were divided into three groups: surgical, 185 patients (28.1%), endovascular, 378 (57.4%), and hybrid, 89 (13.5%). Seven patients (1%) were managed medically only. The primary endpoint of the study occurred in 4.8%, 2.4% and 8.6%, respectively, p=0.01. The secondary endpoint, that included the occurrence of renal or respiratory insufficiency and major bleedings occurred in 10.1%, 6.5% and 23.8%, respectively, p<0.001. At multivariate logistic regression analysis renal insufficiency (OR=2.517; 95%CI=1.077-5.883, p=0.03) and treatment group (endovascular: OR=0.369; 95%CI=0.168-0.813, p=0.01 or hybrid: OR=3.098; 95%CI=1.359-7.060, p=0.007) predicted the primary endpoint.
CONCLUSIONS: Surgical and endovascular treatments yield very good immediate results; the later being less invasive, may be particularly suited to these fragile and complex patients. Long-term follow-up is under assessment.