Tabriz University of Medical Sciences Journal of Cardiovascular and Thoracic Research 2008-5117 18 2 2026 06 30 Does concurrent carotid endarterectomy with coronary artery bypass grafting improve outcomes in patients with dual arterial disease? A systematic review and meta-analysis of randomised controlled trials and propensity-matched studies 93 102 10.34172/jcvtr.33605 EN Kristine Santos https://orcid.org/0009-0004-3563-4211 Giovanna Macanhã Scremin Neel Patel Amal Zakani Mihaela Mariș Tomasz Plonek REVIEW 10.34172/jcvtr.33605 2025 05 31 2026 01 10 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.