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. 

 -  2020 
<br/><br/>Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007 
<br/><br/> 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%). 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0890-5096 
<br/><br/><label>Standard No.: </label>10.1016/j.avsg.2019.06.018 [doi] S0890-5096(19)30593-X [pii] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Carotid Stenosis/su [Surgery]<br/>*Coronary Artery Bypass<br/>*Coronary Stenosis/su [Surgery]<br/>*Endarterectomy, Carotid<br/>Aged<br/>Carotid Stenosis/dg [Diagnostic Imaging]<br/>Carotid Stenosis/mo [Mortality]<br/>Coronary Artery Bypass/ae [Adverse Effects]<br/>Coronary Artery Bypass/mo [Mortality]<br/>Coronary Stenosis/dg [Diagnostic Imaging]<br/>Coronary Stenosis/mo [Mortality]<br/>Endarterectomy, Carotid/ae [Adverse Effects]<br/>Endarterectomy, Carotid/mo [Mortality]<br/>Female<br/>Humans<br/>Ischemic Attack, Transient/mo [Mortality]<br/>Male<br/>Myocardial Infarction/mo [Mortality]<br/>Risk Assessment<br/>Risk Factors<br/>Severity of Illness Index<br/>Stroke/mo [Mortality]<br/>Time Factors<br/>Treatment Outcome
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Medicine/General Internal Medicine
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Review