Synchronous versus Staged Carotid Endarterectomy and Coronary Artery Bypass Graft for Patients with Concomitant Severe Coronary and Carotid Artery Stenosis: A Systematic Review and Meta-analysis

Background: Concurrent carotid artery stenosis and ischaemic heart disease rates are increasing day by day in Bangladesh. Moreover, carotid artery stenosis has been identified as a high-risk factor for postoperative ischaemic cerebral inconvenience following coronary artery bypass graft surgery. Methods: This observational cross-sectional study was performed to evaluate 200 study patients from July 2017 to June 2018. Patients with coronary artery disease scheduled for isolated elective coronary artery bypass graft surgery were included in the study, excluding those with coexisting valvular or congenital heart disease and emergency coronary artery bypass graft surgery. Results: About two-thirds of the study patients were 50–59 years old, with a mean age of 57.7 ± 3.06 years. Approximately 70% patients were male; the male:female ratio was 2.1:1. Most of the patients (74.5%) were Muslim. The majority of patients (59.0%) were overweight, and severe carotid artery stenosis was significantly higher in obese patients (p ⩽ 0.05). Furthermore, hypertension and diabetes mellitus were significantly associated with moderate to severe carotid artery stenosis (p ⩽ 0.05). Multi-vessel coronary artery disease was significantly associated with the severity of carotid artery stenosis. Bilateral carotid artery stenosis was significantly associated with the severity of carotid artery stenosis (p ⩽ 0.05). Conclusion: Routine duplex screening will identify significant carotid artery disease and will subsequently reduce the risk of perioperative stroke in ischaemic heart disease patients undergoing coronary artery bypass graft surgery.

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Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis

Vascular ◽

10.1177/1708538120929506 ◽

2020 ◽

Vol 28 (6) ◽

pp. 808-815

Author(s):

Andreas Tzoumas ◽

Stefanos Giannopoulos ◽

Nektarios Charisis ◽

Pavlos Texakalidis ◽

Damianos G Kokkinidis ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Coronary Artery Bypass Graft ◽

Meta Analysis ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Artery Disease

Background Coronary artery disease requiring coronary artery bypass graft (CABG) frequently coexists with critical carotid stenosis. The most optimized strategy for treating concomitant carotid and coronary artery disease remains debatable. Objective The aim of this meta-analysis was to compare synchronous CAS and CABG versus staged CAS and CABG for patients with concomitant coronary artery disease and carotid artery stenosis in terms of peri-operative (30-day) and long-term clinical outcomes. Methods This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane database until December 2019. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. Results Four studies comprising 357 patients were included in this meta-analysis. Patients who were treated with the synchronous approach had a statistically significant higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00–13.69; I2 = 0%) compared tο the staged group. Peri-operative mortality (OR: 4.50; 95% CI: 0.88–23.01; I2 = 0%), myocardial infarction (MI) (OR: 1.54; 95% CI: 0.18– 13.09; I2 = 0%), postoperative bleeding (OR: 0.27;95% CI: 0.02–3.12; I2 = 0%), transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04– 9.20; I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI: 0.03–4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27; 95% CI: 0.02–3.12; I2 = 0.0%) were similar between the two groups. Synchronous CAS-CABG and staged CAS followed by CABG were associated with similar rates of late mortality (OR: 3.75; 95% CI: 0.50–27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01–12.03; I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84–15.20; I2 = 0.0%) after a mean follow-up of 47 months. Conclusion The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results.

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