title: 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).
abstract: OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Department of Medicine, University of Verona, Italy. flavio.ribichini@univr.it
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Bernhard
authors.initials: B
authors.lastname: Reimers
authors.forename: Paolo
authors.initials: P
authors.lastname: Russo
authors.forename: Raoul
authors.initials: R
authors.lastname: Borioni
authors.forename: Daniela
authors.initials: D
authors.lastname: Spartà
authors.forename: Andrea
authors.initials: A
authors.lastname: Pacchioni
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pesarini
authors.forename: Barbara
authors.initials: B
authors.lastname: Spagnolo
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Persio
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D035843:Biomedical Research / Q000379:methods*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*