Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft versus Staged Carotid Artery Stenting and Coronary Artery Bypass Graft for Patients with Concomitant Severe Coronary and Carotid Stenosis: A Systematic Review and Meta-analysis.
Citation: Annals of Vascular Surgery. 62:463-473.e4, 2020 Jan.PMID: 31449948Institution: MedStar Washington Hospital CenterDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Carotid Stenosis/su [Surgery] | *Coronary Artery Bypass | *Coronary Stenosis/su [Surgery] | *Endarterectomy, Carotid | Aged | Carotid Stenosis/dg [Diagnostic Imaging] | Carotid Stenosis/mo [Mortality] | Coronary Artery Bypass/ae [Adverse Effects] | Coronary Artery Bypass/mo [Mortality] | Coronary Stenosis/dg [Diagnostic Imaging] | Coronary Stenosis/mo [Mortality] | Endarterectomy, Carotid/ae [Adverse Effects] | Endarterectomy, Carotid/mo [Mortality] | Female | Humans | Ischemic Attack, Transient/mo [Mortality] | Male | Myocardial Infarction/mo [Mortality] | Risk Assessment | Risk Factors | Severity of Illness Index | Stroke/mo [Mortality] | Time Factors | Treatment OutcomeYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:- 0890-5096
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 31449948 | Available | 31449948 |
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
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.
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. Copyright (c) 2019 Elsevier Inc. All rights reserved.
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.
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.
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%).
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