Τίτλος:
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
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Tzoumas, A.
Giannopoulos, S.
Charisis, N.
Texakalidis, P.
Kokkinidis, D.G.
Zisis, S.N.
Machinis, T.
Koullias, G.J.
Περιοδικό:
Vascular Specialist International
Εκδότης:
SAGE Publications Ltd
Λέξεις-κλειδιά:
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
DOI:
10.1177/1708538120929506
