Methods of Surgical Treatment of Combined Stenosis of the Carotid and Coronary Arteries. Systematic Review

Abstract

Aim of study. To determine the optimal tactics of surgical treatment of patients with combined stenosis of the carotid and coronary arteries by comparing the results of the simultaneous and staged approach according to the literature.Material and methods. A systematic literature search was performed in the PubMed and MEDLINE databases to compare the results of simultaneous and staged interventions for combined stenosis of the carotid and coronary arteries. The following keywords were used as a search query: (“combined coronary and carotid artery stenosis and simultaneous”), (“combined coronary and carotid artery stenosis and staged”), (“combined coronary and carotid artery stenosis and cost”). We compared the results of simultaneous (interventions on the vessels of both systems are performed simultaneously) and staged operations (interventions are performed alternately, with a time interval from 2 to 160 days). References from included studies were also manually reviewed. The search was conducted by two independent experts (S.L., S.N.), and any disagreement was resolved by the clinical expert (A.A.).Results. A literature search identified 198 potentially relevant studies. A total of 13 studies met the inclusion criteria, of which 5 included two interventions. This systematic analysis includes the results of treatment of 43,758 patients with combined stenosis of the carotid and coronary arteries, who underwent staged or simultaneous revascularization of the vessels of the carotid and coronary flow. Perioperative neurological complications in the group of staged operations were observed somewhat more often than in the group of simultaneous interventions (3.2% versus 4.22%; p=0.8), myocardial infarction was observed with a frequency of 1.5% in the group of simultaneous interventions, and 2.5% (p=0.5) in the group of staged interventions. The mortality rate after simultaneous and staged interventions was 3.9% and 3.6%, respectively, with a fairly high spread in the study groups (p=0.5). Data analysis showed that simultaneous interventions did not affect the incidence of neurological, cardiac complications, and deaths (OR (odds ratio) 1.02; 95% CI (confidence interval) — 0.98–1.14, p = 0, 69; OR — 1.26; 95% CI — 0.66-2.41; p=0.48; and OR — 0.97; 95% CI — 0.67-1.38; p=0.85 — respectively).Conclusion. 1. The cumulative incidence of neurological and cardiac complications and mortality in staged tactics, according to observational studies included in this systematic review, is 4.2%; 2.6% and 3.6%, respectively (p>0.05). 2. The cumulative incidence of neurological and cardiac complications and mortality with simultaneous tactics according to observational studies included in this systematic review is 3.3%; 1.5% and 3.9%, respectively (p>0.05). 3. Given the relatively low risk of developing myocardial infarction (OR — 1.26; 95% CI — 0.66–2.41; I2 — 94%), the low risk of developing neurological complications (OR 1.02; 95% CI — 0,98–1.14; I2=75%), and deaths (OR — 0.97; 95% CI — 0.67–1.38; I2 — 76%) — (p>0.05), with simultaneous interventions, it can be concluded that simultaneous interventions may be the method of choice for surgical treatment for combined stenosis of the carotid and coronary arteries.

Keywords

• stenosis of carotid arteries
• stenosis of coronary arteries
• simultaneous surgery
• staged surgery