Comparative effectiveness of simultaneous and staged operations in patients with atherosclerotic lesions of carotid and coronary arteries

Abstract

Objective: comparative systematic analysis of clinical trials of staged and simultaneous approaches in the surgical treatment of combined carotid and coronary stenosis based on the literature search.Material and methods. A systematic literature search was performed in PubMed/MEDLINE, Google Scholar and Scopus using predefined acceptance criteria. To compare data of simultaneous and staged surgery cumulative indicators of heart attack, stroke and mortality, expressed as percentages and absolute numbers, were analyzed; the Mantel–Hensel formula and the χ2 method were used to assess the relative risk of major adverse cardio-cerebral events development and mortality.Results. The analysis included 7 studies containing one intervention (4 simultaneous and 3 stage methods). The risk of developing myocardial infarction was RR 0.13 (95% CI 0.02–0.67) for simultaneous tactics, and RR 7.79 (95% CI 1.5–40.43) for staged tactics (p˂0.005). The risk of stroke developing was RR 1.29 (95% CI 0.56–2.99) for a simultaneous approach, and RR 0.78 (95% CI 0.33–1.8) for stage approach (p˃0.05). The risk of mortality was RR 0.77 (95% CI 0.31–1.88) for simultaneous procedures, and RR 1.3 (95% CI 0.53–3.18) for staged procedures (p˃0.05).Conclusion. Staged tactics for combined carotid and coronary stenosis may be accompanied by a significantly higher risk of myocardial infarction. There was no statistically significant difference between the groups in terms of the risk of stroke and mortality, but there was a trend towards a higher risk of stroke in the simultaneous group and a higher risk of death from all causes in the staged group.

Keywords

• combined coronary and carotid artery stenosis
• simultaneous surgery
• staged surgery
• coronary artery bypass grafting
• carotid endarterectomy
• carotid revascularization