Shen Yang, Jin Shasha, Lin Changpo, Shen Jianfei, Hong Zhenghua, Xue Song, Guo Daqiao
Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Information and Technology Center of Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China.
Ann Transl Med. 2020 Dec;8(23):1605. doi: 10.21037/atm-20-4451.
Concomitant significant carotid artery occlusive diseases (CAOD) increase the risk of perioperative stroke and death in patients who undergo coronary artery bypass graft (CABG). Although several surgical strategies can be used in the management of such patients, controversy still surrounds which is the best option for CABG patients with accompanying CAOD.
Literature searches will be conducted covering articles published in PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, and Embase between January 1989 and December 2019. Search results will be limited to articles published in English. Six surgical strategies using carotid endarterectomy (CEA) or carotid artery stenting (CAS) with different timings (i.e., before, after, or combined with CABG) will be evaluated. Randomized controlled trials and non-randomized studies comparing these strategies will be included. The quality of studies will be critically appraised using the Cochrane risk-of-bias tool or ROBINS-I tool. Since CEA and CAS have comparable effectiveness for the treatment of significant CAOD, we will integrate direct and indirect evidence using network meta-analysis (NMA) to create hierarchies of the six surgical strategies based on their perioperative safety. The primary outcomes will be the probability of perioperative stroke and the probability of perioperative death. Additionally, we will analyze the probability of perioperative myocardial infarction (MI) as a secondary outcome. Pairwise meta-analyses and Bayesian network meta-analyses will be performed for all related outcome measures. Subgroup analyses, sensitivity analyses, and network meta-regression will be conducted to assess the robustness of the findings.
This NMA will summarize the direct and indirect evidence of perioperative safety with the aim of providing a ranking of the various surgical strategies. The results of this meta-analysis will provide useful information on optimal surgical management of CABG patients with concomitant significant CAOD.
PROSPERO CRD42020162611.
合并严重颈动脉闭塞性疾病（CAOD）会增加接受冠状动脉旁路移植术（CABG）患者围手术期中风和死亡的风险。尽管有几种手术策略可用于此类患者的管理，但对于伴有CAOD的CABG患者哪种是最佳选择仍存在争议。
将进行文献检索，涵盖1989年1月至2019年12月期间发表在PubMed、Cochrane对照试验中央注册库、科学网和Embase上的文章。检索结果将限于以英文发表的文章。将评估六种使用颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）且时机不同（即CABG之前、之后或与之联合）的手术策略。将纳入比较这些策略的随机对照试验和非随机研究。将使用Cochrane偏倚风险工具或ROBINS-I工具对研究质量进行严格评估。由于CEA和CAS在治疗严重CAOD方面具有相当的有效性，我们将使用网络荟萃分析（NMA）整合直接和间接证据，以根据围手术期安全性创建六种手术策略的等级。主要结局将是围手术期中风的概率和围手术期死亡的概率。此外，我们将分析围手术期心肌梗死（MI）的概率作为次要结局。将对所有相关结局指标进行成对荟萃分析和贝叶斯网络荟萃分析。将进行亚组分析、敏感性分析和网络荟萃回归以评估研究结果的稳健性。
这项NMA将总结围手术期安全性的直接和间接证据，旨在对各种手术策略进行排名。这项荟萃分析的结果将为伴有严重CAOD的CABG患者的最佳手术管理提供有用信息。
PROSPERO CRD42020162611。
