Thorac Cardiovasc Surg 2017; 65(04): 302-310
DOI: 10.1055/s-0035-1566262
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

A Systematic Review of Early Results Following Synchronous or Staged Carotid Artery Stenting and Coronary Artery Bypass Grafting

Jianbin Zhang
1  Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
,
Rong Wei Xu
1  Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
,
Xueqiang Fan
1  Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
,
Zhidong Ye
1  Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
,
Peng Liu
1  Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
› Author Affiliations
Further Information

Publication History

13 July 2015

26 September 2015

Publication Date:
04 November 2015 (online)

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.