Carotid endarterectomy in the elderly: does gender effect outcome?
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.
Ozsvath
Kathleen J
KJ
Institute for Vascular Health and Disease, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
Darling
R Clement
RC
Tabatabai
Laila
L
Roddy
Sean P
SP
Paty
Philip S K
PS
Chang
Benjamin B
BB
Kreienberg
Paul B
PB
Mehta
Manish
M
Shah
Dhiraj M
DM
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