title: Early and long-term outcomes after combined percutaneous revascularization in patients with carotid and coronary artery stenoses.
abstract: OBJECTIVE
  This study sought to evaluate the 30-day and long-term clinical outcomes of patients with carotid obstructive disease (COD) and concomitant coronary artery disease (CAD) undergoing a combined percutaneous revascularization, in 4 high-volume centers skilled for the treatment of multilevel vascular disease.
  
  
  BACKGROUND
  The optimal management of patients with COD and concomitant CAD remains controversial. A variety of therapeutic strategies, including coronary artery bypass grafting, alone or in combination with carotid artery revascularization, have been reported.
  
  
  METHODS
  Between January 2006 and April 2010, 239 consecutive patients with COD (symptomatic carotid stenosis in 20.5%) and concomitant CAD were treated with staged or simultaneous carotid artery stenting and percutaneous coronary intervention, and enrolled in this prospective registry. The primary endpoint was the incidence of major cardiac and cerebrovascular events, including any death, myocardial infarction, or stroke occurring between the first revascularization procedure and 30 days after treatment of the second vascular territory affected.
  
  
  RESULTS
  The incidence of the primary endpoint at 30 days was 4.2% (95% confidence interval [CI]: 2.02 to 7.56). The rate of death, myocardial infarction, and stroke at long-term follow-up (median 520 days) was 4.2%, 2.1%, and 3.8%, respectively. At long-term follow-up, patients with previous cardiovascular disease had significantly higher rates of major cardiac and cerebrovascular events than did patients with a first clinical episode (17% vs. 6%, hazard ratio: 3.34; 95% CI: 1.46 to 7.63; p = 0.004).
  
  
  CONCLUSIONS
  In patients with COD and concomitant CAD, a combined percutaneous treatment compares favorably with previous surgical or hybrid experiences. Such strategy may be particularly suited to complex patients at high surgical risk.
authors: Department of Cardiovascular Sciences, European Hospital, Rome, Italy. f.tomai@tiscali.it
authors: Fabrizio
authors: F
authors: Tomai
authors: Gabriele
authors: G
authors: Pesarini
authors: Fausto
authors: F
authors: Castriota
authors: Bernhard
authors: B
authors: Reimers
authors: Leonardo
authors: L
authors: De Luca
authors: Giovanni
authors: G
authors: De Persio
authors: Daniela
authors: D
authors: Spartà
authors: Cristina
authors: C
authors: Aurigemma
authors: Andrea
authors: A
authors: Pacchioni
authors: Barbara
authors: B
authors: Spagnolo
authors: Alberto
authors: A
authors: Cremonesi
authors: Flavio
authors: F
authors: Ribichini