Related Experiment Video
Updated: Aug 4, 2026
Training a Sophisticated Microsurgical Technique: Interposition of External Jugular Vein Graft in the Common Carotid Artery in Rats
Published on: November 11, 2012
Carotid Stenting Prior to Coronary Bypass Surgery: An Updated Systematic Review and Meta-Analysis
K I Paraskevas1, S Nduwayo1, A N Saratzis1
1The Department of Vascular Surgery at Leicester Royal Infirmary, Leicester, UK.
Insights
For patients with concurrent carotid and cardiac disease, same-day carotid artery stenting (CAS) plus coronary artery bypass grafting (CABG) showed similar 30-day death/stroke rates compared to staged procedures. Outcomes were worse for symptomatic patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Concurrent carotid and cardiac disease presents a complex management challenge.
- Carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) are common interventions for these conditions.
- The optimal timing and sequence of CAS and CABG remain subjects of investigation.
Purpose of the Study:
- To determine 30-day outcomes in patients with concurrent carotid and cardiac disease undergoing CAS followed by CABG.
- To compare outcomes between same-day and staged CAS + CABG procedures.
- To evaluate the impact of different antiplatelet strategies on outcomes.
Main Methods:
- A systematic review of PubMed/Medline, Embase, and Cochrane databases was conducted.
- Studies involving "same-day" CAS + CABG and "staged" interventions (at least 1 day apart) were included.
- Data on 30-day mortality, stroke, and myocardial infarction were extracted and analyzed.
Main Results:
- 31 studies with 2727 patients were analyzed; 80% were asymptomatic with unilateral stenoses.
- The overall 30-day death/stroke rate was 7.9%.
- Staged CAS + CABG had a 30-day death/stroke rate of 8.5% versus 5.9% for same-day procedures. Symptomatic patients had higher stroke rates (15%).
- Different antiplatelet strategies showed varying rates of death/stroke/MI and bleeding complications, with insufficient data for definitive conclusions on optimal regimens.
Conclusions:
- In predominantly asymptomatic patients with unilateral carotid stenoses, the 30-day death/stroke rate after CAS + CABG is approximately 8%.
- This meta-analysis did not find evidence of significantly higher adverse outcomes with same-day CAS + CABG compared to staged procedures.
- Outcomes were poorer in neurologically symptomatic patients, and further research is needed to determine the optimal antiplatelet strategy.
Objectives:
The aim was to determine 30-day outcomes in patients with concurrent carotid and cardiac disease who underwent carotid artery stenting (CAS) followed by coronary artery bypass grafting (CABG).
Methods:
This was a systematic review with searches of PubMed/Medline, Embase, and Cochrane databases. "Same-day" procedures involved CAS + CABG being performed on the same day, and "staged" interventions involved at least 1 day's delay between undergoing CAS and then CABG.
Results:
There were 31 eligible studies (2727 patients), with 80% being neurologically asymptomatic with unilateral stenoses. Overall, the 30-day death/stroke rate was 7.9% (95% confidence interval [CI] 6.9-9.2), while death/stroke/MI was 8.8% (95% CI 7.3-10.5). Staged CAS + CABG was associated with 30-day death/stroke rate of 8.5% (95% CI 7.3-9.7) compared with 5.9% (95% CI 4.0-8.5) after "same-day" procedures. Outcomes following CAS + CABG in neurologically symptomatic patients were poorer, with procedural stroke rates of 15%. There were five antiplatelet (APRx) strategies: (a) no APRx (death/stroke/MI, 4.2%; no data on bleeding complications); (b) single APRx before CAS and CABG, then dual APRx after CABG (death/stroke/MI, 6.7%; 7.3% bleeding complications); (c) dual APRx pre-CAS down to one APRx pre-CABG (death/stroke/MI, 10.1%; 2.8% bleeding complications); (d) dual APRx pre-CAS, both stopped pre-CABG (death/stroke/MI, 14.4%); (e) dual APRx pre-CAS and continued through CABG (death/stroke/MI, 16%). There were insufficient data on bleeding complication in the last two strategies.
Conclusions:
In a cohort of predominantly asymptomatic patients with unilateral carotid stenoses, the 30-day rate of death/stroke was about 8%. Notwithstanding the effect of potential biases, this meta-analysis did not find evidence that outcomes after same-day CAS + CABG were higher than after staged interventions. However, outcomes were poorer in neurologically symptomatic patients. More data are required to establish the optimal antiplatelet strategy in patients undergoing same-day or staged CAS + CABG.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:26Angina IV: Management