title: Octogenarians with contralateral carotid artery occlusion: a cohort at higher risk for carotid endarterectomy?
abstract: OBJECTIVE
  Carotid angioplasty and stenting has been proposed as a treatment option for carotid occlusive disease in patients at high risk, including those 80 years of age or older or with contralateral carotid occlusion. We analyzed 30-day mortality and stroke risk rates of carotid endarterectomy (CEA) in patients aged 80 years or older with concurrent carotid occlusive disease.
  
  
  METHODS
  From a retrospective review of 1000 patients undergoing 1150 CEA procedures to treat symptomatic and asymptomatic carotid lesions over 13 years, we identified 54 patients (5.4%) aged 80 years or older with concurrent contralateral carotid occlusion. These patients were compared with 38 patients (3.8%) aged 80 years or older with normal or diseased patent contralateral carotid artery and 81 patients (8.1%) younger than 80 years with contralateral carotid occlusion. All CEA procedures involved either standard CEA with patching or eversion CEA, and were performed by the same surgeon, with the patients under deep general anesthesia and cerebral protection involving continuous perioperative electroencephalographic monitoring for selective shunting. Shunting criteria were based exclusively on electroencephalographic abnormalities consistent with cerebral ischemia.
  
  
  RESULTS
  The 30-day mortality and stroke rate in patients aged 80 years or older with concurrent contralateral carotid occlusion was zero.
  
  
  CONCLUSIONS
  The concept of high-risk CEA needs to be revisited. Patients with two of the criteria considered high risk in the medical literature, that is, age 80 years or older and contralateral carotid occlusion, can undergo CEA with no greater risks or complications. Until prospective randomized trials designed to evaluate the role of carotid angioplasty and stenting have been completed, CEA should remain the standard treatment in such patients.
authors.affiliation: Section of Vascular Surgery, University of Padua School of Medicine, Padua, Italy. enzo.ballotta@unipd.it
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.forename: Laura
authors.initials: L
authors.lastname: Renon
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Da Giau
authors.forename: Bruno
authors.initials: B
authors.lastname: Barbon
authors.forename: Oreste
authors.initials: O
authors.lastname: Terranova
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000401:mortality / Q000601:surgery*; D002343:Carotid Artery, Internal; D016022:Case-Control Studies; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000453:epidemiology