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

Abstract Background Due to the systemic nature of atherosclerosis, medium and large arteries at different sites are commonly simultaneously affected. As a result, severe coronary artery disease (CAD) requiring coronary artery bypass graft (CABG) frequently coexists with significant carotid stenosis that warrants revascularization. Objective 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. 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 between the two groups. However, patients who underwent simultaneous CEA and 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.