@article{3120494,
    title = "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",
    author = "Tzoumas, A. and Giannopoulos, S. and Charisis, N. and Texakalidis, P. and Kokkinidis, D.G. and Zisis, S.N. and Machinis, T. and Koullias, G.J.",
    journal = "Vascular Specialist International",
    year = "2020",
    volume = "28",
    number = "6",
    pages = "808-815",
    publisher = "SAGE Publications Ltd",
    doi = "10.1177/1708538120929506",
    keywords = "low molecular weight heparin, acute kidney failure;  adult;  carotid arteriography;  carotid artery obstruction;  carotid artery stenting;  carotid endarterectomy;  computed tomographic angiography;  coronary angiography;  coronary artery bypass graft;  coronary artery disease;  dual antiplatelet therapy;  female;  heart infarction;  heart muscle ischemia;  human;  male;  Review;  sternotomy;  systematic review;  adverse event;  aged;  carotid artery obstruction;  complication;  coronary artery obstruction;  devices;  diagnostic imaging;  endovascular surgery;  meta analysis;  middle aged;  mortality;  risk assessment;  risk factor;  severity of illness index;  stent;  time factor;  treatment outcome, Aged;  Carotid Stenosis;  Coronary Artery Bypass;  Coronary Stenosis;  Endovascular Procedures;  Female;  Humans;  Male;  Middle Aged;  Risk Assessment;  Risk Factors;  Severity of Illness Index;  Stents;  Time Factors;  Treatment Outcome",
    abstract = "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. © The Author(s) 2020."
}