Kristine Santos
1,2* 
, Giovanna Macanhã Scremin
3, Neel Patel
1, Amal Zakani
4, Mihaela Ioana Mariș
5, Tomasz Płonek
21 New Vision University School of Medicine, Tbilisi, Georgia
2 Medisch Spectrum Enschede, Enschede, Netherlands
3 Pontifical Catholic University of Paraná, Curitiba, Brazil
4 Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
5 Center 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.