在因冠状动脉旁路移植手术而被选中的患者中，针对颈动脉狭窄进行颈动脉内膜切除术。
Carotid endarterectomy for carotid stenosis in patients selected for coronary artery bypass graft surgery.
作者信息
Mortaz Hejri Sara, Mostafazadeh Davani Babak, Sahraian Mohamad Ali
机构信息
Student's Scientific Research Center, Tehran University of Medical Sciences, Pursina Ave, Keshavarz Blvd, Tehran, Iran.
出版信息
Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD006074. doi: 10.1002/14651858.CD006074.pub2.
BACKGROUND
Carotid stenosis and coronary artery disease can occur simultaneously. In patients with coronary artery disease who are scheduled for coronary artery bypass graft (CABG) surgery, but who also have carotid artery stenosis, there is controversy about the role of carotid surgery. It is not known whether any benefit from prophylactic carotid endarterectomy (by avoiding stroke and neurological dysfunction complicating CABG surgery) outweighs the risks.
OBJECTIVES
To assess, in patients undergoing CABG surgery with a carotid stenosis more than 50%, the effects of carotid endarterectomy plus best medical therapy compared with best medical therapy alone on the overall risk of major clinical outcomes including death, stroke, and myocardial infarction.
SEARCH STRATEGY
We searched the trials registers of the Cochrane Stroke Group (searched October 2008) and the Cochrane Heart Group (searched November 2008). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2008), MEDLINE (1966 to November 2008), EMBASE (1980 to November 2008), reference lists of identified trials, and ongoing trials and research registers (last searched November 2008).
SELECTION CRITERIA
We planned to include all truly randomised controlled trials comparing carotid endarterectomy plus best medical therapy with best medical therapy alone in patients selected for CABG surgery. The main outcome was perioperative death.
DATA COLLECTION AND ANALYSIS
We planned for two review authors to independently assess the methodological quality of included studies, and extract data.
MAIN RESULTS
We did not find any eligible studies.
AUTHORS' CONCLUSIONS: We found no evidence from randomised trials by which to assess the benefits and risks of prophylactic carotid surgery before CABG surgery. Randomised controlled trials are required to reliably document the risks and benefits of such procedures.
背景
颈动脉狭窄和冠状动脉疾病可能同时发生。对于计划进行冠状动脉旁路移植术（CABG）但同时患有颈动脉狭窄的冠心病患者，颈动脉手术的作用存在争议。尚不清楚预防性颈动脉内膜切除术（通过避免CABG手术并发中风和神经功能障碍）的任何益处是否超过风险。
目的
在接受CABG手术且颈动脉狭窄超过50%的患者中，评估颈动脉内膜切除术加最佳药物治疗与单纯最佳药物治疗相比，对包括死亡、中风和心肌梗死在内的主要临床结局总体风险的影响。
检索策略
我们检索了Cochrane卒中小组（2008年10月检索）和Cochrane心脏小组（2008年11月检索）的试验注册库。此外，我们检索了Cochrane对照试验中央注册库（CENTRAL）（《Cochrane图书馆》2008年第4期）、MEDLINE（1966年至2008年11月）、EMBASE（1980年至2008年11月）、已识别试验的参考文献列表以及正在进行的试验和研究注册库（最后检索时间为2008年11月）。
选择标准
我们计划纳入所有在选定进行CABG手术的患者中，比较颈动脉内膜切除术加最佳药物治疗与单纯最佳药物治疗的真正随机对照试验。主要结局是围手术期死亡。
数据收集与分析
我们计划由两位综述作者独立评估纳入研究的方法学质量，并提取数据。
主要结果
我们未找到任何符合条件的研究。
作者结论
我们未从随机试验中找到证据来评估CABG手术前预防性颈动脉手术的益处和风险。需要进行随机对照试验来可靠地记录此类手术的风险和益处。
Zotero 插件