Giannopoulos Stefanos, Texakalidis Pavlos, Charisis Nektarios, Jonnalagadda Anil K, Chaitidis Nikolaos, Giannopoulos Spyridon, Kaskoutis Christos, Machinis Theofilos, Koullias George J
Department of Vascular Surgery, 251 HAF and VA Hospital, Athens, Greece.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA.
Ann Vasc Surg. 2020 Jan;62:463-473.e4. doi: 10.1016/j.avsg.2019.06.018. Epub 2019 Aug 23.
Owing to the systemic nature of atherosclerosis, medium and large arteries at different sites are commonly simultaneously affected. As a result, severe coronary artery disease (CAD) requiring coronary artery bypass graft (CABG) frequently coexists with significant carotid stenosis that warrants revascularization. The aim of this study was to compare synchronous carotid endarterectomy (CEA) and CABG vs. staged carotid artery stenting (CAS) and CABG for patients with concomitant CAD and carotid artery stenosis in terms of perioperative (30-day) outcomes.
This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a search of PubMed, Scopus, and Cochrane until July 2018. A meta-analysis was conducted with the use of a random-effects model. The I-square statistic was used to assess heterogeneity.
Five studies comprising 16,712 patients were included in this meta-analysis. Perioperative stroke (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.43-1.64; I = 39.1%), transient ischemic attack (TIA; OR: 0.32; 95% CI: 0.04-2.67; I = 27.6%), and myocardial infarction (MI) rates (OR: 0.56; 95% CI: 0.08-3.85; I = 68.9%) were similar between the two groups. However, patients who underwent simultaneous CEA and CABG were at a statistically significant higher risk for perioperative mortality (OR: 1.80; 95% CI: 1.05-3.06; I = 0.0%).
The current meta-analysis did not detect statistically significant differences in the rates of perioperative stroke, TIA, and MI between the groups. However, patients in the simultaneous CEA and CABG group had a significantly higher risk of 30-day mortality. Future randomized trials or prospective cohorts are needed to validate our results.
由于动脉粥样硬化具有全身性，不同部位的中、大动脉通常会同时受到影响。因此，需要冠状动脉旁路移植术（CABG）的严重冠状动脉疾病（CAD）常常与需要血运重建的严重颈动脉狭窄同时存在。本研究的目的是比较同期颈动脉内膜切除术（CEA）联合CABG与分期颈动脉支架置入术（CAS）联合CABG治疗合并CAD和颈动脉狭窄患者的围手术期（30天）结局。
本研究按照系统评价和Meta分析的首选报告项目指南进行。通过检索PubMed、Scopus和Cochrane数据库，直至2018年7月，确定符合条件的研究。采用随机效应模型进行Meta分析。使用I²统计量评估异质性。
本Meta分析纳入了5项研究，共16712例患者。两组围手术期卒中（优势比[OR]：0.84；95%置信区间[CI]：0.43 - 1.64；I² = 39.1%）、短暂性脑缺血发作（TIA；OR：0.32；95% CI：0.04 - 2.67；I² = 27.6%）和心肌梗死（MI）发生率（OR：0.56；95% CI：0.08 - 3.85；I² = 68.9%）相似。然而，同期接受CEA和CABG的患者围手术期死亡风险在统计学上显著更高（OR：1.80；95% CI：1.05 - 3.06；I² = 0.0%）。
目前的Meta分析未发现两组在围手术期卒中、TIA和MI发生率上存在统计学显著差异。然而，同期CEA和CABG组的患者30天死亡风险显著更高。需要未来的随机试验或前瞻性队列研究来验证我们的结果。
