Does Concurrent Carotid Endarterectomy with Coronary Artery Bypass Grafting Improve Outcomes in Patients with Dual Arterial Disease? A Systematic Review and Meta-Analysis.
5 affiliations
- 1New Vision University School of Medicine, Tbilisi, Georgia.
- 2Medisch Spectrum Enschede, Enschede, Netherlands.
- 3Pontifical Catholic University of Paraná, Curitiba, Brazil.
- 4Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco.
- 5Center for Translational Research and Systems Medicine, "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Romania.
Abstract
Patients with coexisting carotid and coronary artery disease face a complex surgical decision regarding whether to undergo coronary artery bypass grafting (CABG) alone or combined with carotid endarterectomy (CEA). Evidence remains conflicting, with some studies suggesting stroke reduction from a combined approach while others report increased perioperative morbidity without a survival advantage, contributing to weak ACCF/AHA and ESC/EACTS guideline recommendations. We conducted a systematic review and meta-analysis of randomised controlled trials and propensity-matched studies comparing CABG alone versus CABG+CEA. Five studies involving 23,916 patients were included, of whom 29% underwent combined surgery. CABG+CEA was associated with a significantly higher incidence of perioperative stroke (OR 1.5; 95% CI 1.1-2.0; P=0.03), but no significant differences were observed in 30-day mortality, major adverse cardiovascular events, myocardial infarction, or hospital length of stay. These findings indicate that adding CEA to CABG increases stroke risk without providing a clear survival benefit, supporting guideline recommendations for a selective, risk-based strategy. Until higher-quality evidence becomes available, concurrent CEA+CABG should be reserved for carefully selected patients in whom the anticipated benefits outweigh potential harms.
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BibTeX
@article{santos2026does,
title = {{Does Concurrent Carotid Endarterectomy with Coronary Artery Bypass Grafting Improve Outcomes in Patients with Dual Arterial Disease? A Systematic Review and Meta-Analysis.}},
author = {Kristine Santos and Giovanna Macanhã Scremin and Neel Patel and Amal Zakani and Mihaela Ioana Mariș and Tomasz Płonek},
journal = {Journal of cardiovascular and thoracic research},
year = {2026},
month = jun,
doi = {10.34172/jcvtr.33605},
url = {https://europepmc.org/article/MED/42898308},
note = {CC BY},
}
RIS
TY - JOUR
TI - Does Concurrent Carotid Endarterectomy with Coronary Artery Bypass Grafting Improve Outcomes in Patients with Dual Arterial Disease? A Systematic Review and Meta-Analysis.
AU - Kristine Santos
AU - Giovanna Macanhã Scremin
AU - Neel Patel
AU - Amal Zakani
AU - Mihaela Ioana Mariș
AU - Tomasz Płonek
PY - 2026
DA - 2026/06/30
JO - Journal of cardiovascular and thoracic research
DO - 10.34172/jcvtr.33605
UR - https://europepmc.org/article/MED/42898308
AB - Patients with coexisting carotid and coronary artery disease face a complex surgical decision regarding whether to undergo coronary artery bypass grafting (CABG) alone or combined with carotid endarterectomy (CEA). Evidence remains conflicting, with some studies suggesting stroke reduction from a combined approach while others report increased perioperative morbidity without a survival advantage, contributing to weak ACCF/AHA and ESC/EACTS guideline recommendations. We conducted a systematic review and meta-analysis of randomised controlled trials and propensity-matched studies comparing CABG alone versus CABG+CEA. Five studies involving 23,916 patients were included, of whom 29% underwent combined surgery. CABG+CEA was associated with a significantly higher incidence of perioperative stroke (OR 1.5; 95% CI 1.1-2.0; P=0.03), but no significant differences were observed in 30-day mortality, major adverse cardiovascular events, myocardial infarction, or hospital length of stay. These findings indicate that adding CEA to CABG increases stroke risk without providing a clear survival benefit, supporting guideline recommendations for a selective, risk-based strategy. Until higher-quality evidence becomes available, concurrent CEA+CABG should be reserved for carefully selected patients in whom the anticipated benefits outweigh potential harms.
SN - 2008-5117
SN - 2008-6830
ER -