Advancements in carotid stenting leading to reductions in perioperative morbidity among patients 80 years and older.
OBJECTIVE
Patients 80 years and older are generally considered to be at an increased risk for stroke and death from carotid endarterectomy. High-risk status often qualifies them for entry into a carotid angioplasty and stenting (CAS) trial. The aim of this study is to report periprocedure (0-30 d) morbidity and mortality among elderly patients undergoing CAS with and without distal embolic protection in an intention-to-treat analysis.


METHODS
A retrospective review was performed to evaluate the medical records and imaging studies of patients 80 years or older who underwent attempted CAS procedures with and without distal embolic protection between June 1996 and February 2004.


RESULTS
Ages of the 75 patients identified in our review ranged from 80 to 91 years (average 83.1 yr); 41 were men. Internal carotid artery stenosis ranged from 60 to 95% (mean 78.3%). Forty-two patients had symptoms (transient ischemic attack, 29; stroke, 13), and 33 patients were asymptomatic. Total event rates were major stroke, 4% (3 patients); minor stroke, 6.7% (5 patients); death, 4% (3 patients). Rates in the unprotected group (35 patients) were major stroke, 8.6% (3 patients); minor stroke, 5.7% (2 patients); major stroke/death, 14.3% (5 patients). Rates in the protected group (40 patients) were major stroke, 0; minor stroke, 7.5% (3 patients); major stroke/death, 0; (P < 0.05).


CONCLUSIONS
These results suggest that elderly patients undergoing CAS with adjunctive distal embolic protection are at a lower risk of periprocedure adverse events. Routine clopidogrel use, smaller hardware profile, patient selection, and increased experience likely contributed to these results.
Villalobos
Hunaldo J
HJ
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo 14209, USA.
Harrigan
Mark R
MR
Lau
Tsz
T
Wehman
J Christopher
JC
Hanel
Ricardo A
RA
Levy
Elad I
EI
Guterman
Lee R
LR
Hopkins
L Nelson
LN
D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000453:epidemiology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology