Abstract
Background The optimal management of patients with concomitant coronary artery disease (CAD)
and severe carotid artery stenosis remains a controversy. We performed a systematic
review of studies comparing early outcomes of synchronous or staged carotid artery
stenting (CAS) and coronary artery bypass grafting (CABG) in the treatment of patients
with concomitant CAD and severe carotid artery stenosis.
Methods Multiple databases were systematically searched to identify studies of synchronous
or staged CAS and CABG in the treatment of concomitant severe carotid and coronary
artery disease published from 2005 to 2015. The quality of studies was assessed using
the MINORS scale. The demographic data, risk factors, 30-day outcomes, and antiplatelet
strategy were extracted.
Results 23 studies were identified with a total of 873 and 459 patients in the staged and
synchronous group, respectively. The observed overall death/stroke/MI rate was 8.5%
(95% CI: 7.6–9.4%) in staged group and 4.8% (95% CI: 3.8–5.8%) in synchronous group.
It seems that the synchronous group has better 30-day outcomes, but these data could
not be compared statistically.
Conclusion Our systematic review suggests either synchronous or staged CAS and CABG can be chosen
for the treatment of concomitant carotid and coronary artery disease. It seems that
the synchronous approach is relatively convenient and the antiplatelet strategy is
relatively definite. For these patients, hybrid revascularization by synchronous CAS
and CABG might be a feasible and promising therapeutic strategy. Our conclusions and
the quality of the existing data suggest that a randomized controlled trial is needed
to define the best treatment for patients with concomitant carotid and coronary artery
disease.
Keywords
cardiac - carotid arteries - coronary artery bypass surgery - stents
