Strategie combinate di rivascolarizzazione cardiaca e periferica.Il progetto FRIENDS.

The co-existence of atherosclerosis in different vascular districts is known as polivascular disease, a pathological condition that continues to expand in parallel with life expectancy. In this study we have enrolled 949 patients with coronary artery disease (CAD) and concomitant carotid obstructive disease (COD). A large body of evidence is available regarding the treatment of patient with CAD, less information has been obtained from patients with COD and very little is known about the advantages, shortcomings, and long term outcomes of patients having concomitant CAD and COD. Our results were obtained in a population of old patients with several comorbidities and cardiovascular risk factors with a coronary multivessel disease in more than 50%. The aim of this study is to asses the 30-day and 1-year clinical outcome of endovascular, surgical and hybrid (approach that includes both form of treatment) revascularization procedures. The incidence of the primary end-point (1-year death, myocardial infarction, stroke) was 5.3% for the surgical group, 2.3% for the endovascular group and 7.4% for the hybrid group. Events included in the secondary end-points were statistically much higher in the hybrid group than in the surgical and endovascular groups, particularly major bleeding (22.3% vs 2% in the endovascular groups and 6.4% in the surgical groups) p<0.001. Patients included in the hybrid group had the higher event-free 1 year survival with a significant statistical difference between the surgical and the endovascular groups (96.7 ± 1.6, 91.0 ± 1.7 and 94.6 ± 1.6 respectively). Surgical and endovascular treatments yield good immediate and long-term results. However, the good results of the endovascular strategy suggest that this approach may be particularly suited to complex patients at high surgical risk.