title: Carotid endarterectomy in the elderly: does gender effect outcome?
abstract: OBJECTIVE
  Carotid endarterectomy (CEA) has a positive effect on stroke free survival in patients with either symptomatic or asymptomatic severe carotid bifurcation stenosis. However, most trials have excluded octogenarians. In addition, concerns have arisen regarding the benefits of CEA in the elderly population, especially in women. In this study, we performed an outcome analysis in patients undergoing CEA comparing those eighty and older to their younger counterparts. Additionally, we evaluated the elderly group based on gender.
  
  
  METHODS
  Over the past 10 years, all patients undergoing CEA for asymptomatic and symptomatic carotid disease have been entered into our vascular surgery registry. Demographics, indications for operative intervention, outcomes and survival of patients who had undergone CEA were reviewed. Procedures were preferentially performed under regional anesthesia with selective shunting. Chi square analysis was used to assess significance and assumed for P<0.05.
  
  
  RESULTS
  Over the last 10 years, 125 carotid endarterectomies were performed in 125 patients eighty years of age or older. Fifty-six were male and 69 were female. Mean age was 83 (range: 80-97). Asymptomatic disease was identified in 28 of the male patients (50%) and 44 of the female patients (64%). There were no deaths and a permanent neurological deficit occurred in one female patient. There was no difference in thirty-day morbidity or mortality in female patients compared to males.
  
  
  CONCLUSIONS
  These observations suggest that CEA can be safely performed in selected elderly patients with asymptomatic or symptomatic carotid artery stenosis. Furthermore, women over 80 may expect equally optimistic results as their male counterparts.
authors.affiliation: Institute for Vascular Health and Disease, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Ozsvath
authors.forename: R Clement
authors.initials: RC
authors.lastname: Darling
authors.forename: Laila
authors.initials: L
authors.lastname: Tabatabai
authors.forename: Sean P
authors.initials: SP
authors.lastname: Roddy
authors.forename: Philip S K
authors.initials: PS
authors.lastname: Paty
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Chang
authors.forename: Paul B
authors.initials: PB
authors.lastname: Kreienberg
authors.forename: Manish
authors.initials: M
authors.lastname: Mehta
authors.forename: Dhiraj M
authors.initials: DM
authors.lastname: Shah
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000517:prevention & control; D016019:Survival Analysis; D016896:Treatment Outcome