Society For Clinical Vascular Surgery

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Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft (CABG) versus staged Carotid Artery Stenting and CABG for Patients with Concomitant Severe Coronary and Carotid Stenosis: a Systematic Review and Meta-analysis
Nektarios Charisis, MD1, Stefanos Giannopoulos, MD2, Pavlos Texakalidis, MD3, Nikolaos Chaitidis, MD4, George J. Koullias, MD, PhD1.
1Stony Brook University Hospital, Stony Brook, NY, USA, 2251 HAF and VA Hospital, Athens, Greece, 3Emory University Hospital, Atlanta, GA, USA, 4401 General Military Hospital, Athens, Greece.

OBJECTIVES: Severe coronary artery disease (CAD) requiring coronary artery bypass graft (CABG) frequently coexists with significant carotid stenosis that warrants revascularization. 2011 ACC and AHA guidelines support CAS as an alternative to CEA in defined patient subsets. In this study, we tried to compare synchronous carotid endarterectomy (CEA) and CABG vs. staged carotid artery stenting (CAS) and CABG for patients with concomitant CAD and carotid artery stenosis in terms of peri-operative (30-day) outcomes.
METHODS: This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane until July, 2018. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity.
RESULTS: Five studies comprising 16,712 patients were included in this meta-analysis; 15,727 of these patients underwent synchronous CEA and CABG and 985 underwent staged CAS and CABG. Peri-operative stroke (odds ratio (OR): 0.84; 95% confidence interval (CI): 0.43- 1.64; I2= 39.1%), transient ischemic attack (TIA) (OR: 0.32; 95% CI: 0.04- 2.67; I2= 27.6%) and myocardial infarction (MI) rates (OR: 0.56; 95% CI: 0.08- 3.85; I2= 68.9%) were similar in the study groups. However, patients who underwent simultaneous CEA & CABG were at a statistically significant higher risk for peri-operative mortality (OR: 1.80; 95% CI: 1.05- 3.06; I2= 0.0%).
CONCLUSIONS: The current meta-analysis did not detect statistically significant differences in the rates of peri-operative stroke, TIA and MI between the groups. However, patients in the simultaneous CEA and CABG group had a significantly higher risk of 30-day mortality. Future randomized trials or prospective cohorts are needed to validate our results.


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