NEW YORK (Reuters Health) – In patients with both carotid and coronary stenosis, a percutaneous approach to treating both sites — simultaneously or within a close period — yields results that compare favorably to previous strategies, an Italian team reports in the May issue of JACC: Cardiovascular Interventions.

Dr. Fabrizio Tomai, with the European Hospital in Rome, and colleagues explain that the optimal treatment of patients with severe carotid obstructive disease (COD) and concomitant coronary artery disease (CAD) is not well established. They note that coronary artery bypass surgery with simultaneous or staged carotid endarterectomy or carotid stenting have been attempted in such patients but the incidence of death, stroke or MI has been high at 7% to 14%.

Since carotid artery stenting (CAS) and percutaneous coronary intervention (PCI) have been shown to be acceptable alternatives to CEA and CABG, the team reasoned that combined percutaneous revascularization “might be particularly appropriate for such a complex subset of patients at high surgical risk.”

To investigate, Dr. Tomai’s team looked at short- and long-term outcomes in 239 consecutive patients with concomitant carotid and coronary artery disease treated with PCI and CAS, either on the same day (simultaneously) or within 1-45 days (staged).

At 30 days after the second procedure, the incidence of the composite primary endpoint of death, stroke or MI was 4.2%, according to the report.

At a median follow-up of 520 days, the mortality rate was 4.2%, and the rates of MI and stroke were 2.1% and 3.8%, respectively, the team found

In discussing the results, the authors point out that the combined percutaneous approach offers several advantages in this setting: its less invasive nature is particularly appropriate for complex patients, the sequence of the two procedures is easier to plan, and hospital stay is shorter.

They conclude, “In patients with COD and concomitant CAD, a combined percutaneous treatment performed in high-volume centers skilled for vascular care yields good immediate and long-term results. Thus, it may be a valuable alternative to the entirely surgical or hybrid approaches.”

However, they add, “Further studies are warranted to confirm the safety and durability of this combined percutaneous approach.”

J Am Coll Cardiol Intv 2011;4:560–568.