Early and late clinical outcomes of endovascular, surgical, and hybrid revascularization strategies of combined carotid and coronary artery diseases: the FRIENDS study group (Finalized Research In ENDovascular Strategies)

The best therapeutic strategy for patients with concomitant carotid obstructive disease (COD) and coronary artery disease (CAD) remains controversial. The aim of the study is to observe post-procedural and 1-year clinical outcomes of patients with COD and CAD after an endovascular, surgical, or a combined (hybrid) revascularization approach, selected by consensus of a multidisciplinary team. Between January 2006 and December 2012, 1043 consecutive patients with COD and concomitant CAD were treated. According to treatment strategies, patients were divided into three groups: surgical: 391 patients (37.1%), endovascular: 502 (48.1%), and hybrid (combined surgical and percutaneous revascularization): 129 (12.4%). The remaining 21 patients were managed medically only and not analysed. The primary end point of the study was a composite of death, myocardial infarction (MI), and stroke at 1-year follow-up; secondary end points included a composite of death, MI, and stroke in-hospital, and major bleeding complications. In hospital, mortality was higher in the surgical group (2.3 vs. 0.2 and 0%, P < 0.001), more strokes occurred in the endovascular group (2.0 vs. 0.5 and 0.8%, P = 0.03), and major bleedings were more frequent among hybrid patients (13.9 vs. 3.8 and 5.5%, P = 0.001). The incidence rate of the primary end point (hierarchical at 1 year) occurred in 6.0% of the study population (5.8, 6.5, and 4.6%, respectively; P = ns for all groups). Surgical and endovascular treatments yield remarkable clinical results both at acute and 1-year follow-up. The best-suited revascularization strategy should be discussed in a multidisciplinary context, and chosen according to the clinical characteristics of each single case and local expertise.