High-grade symptomatic and asymptomatic carotid stenosis in the very elderly. A challenge for proponents of carotid angioplasty and stenting.
BACKGROUND
Carotid angioplasty and stenting (CAS) is often considered as the preferred treatment for severe carotid occlusive disease in patients labelled as "high risk", including those aged 80 or more. We analyzed 30-day stroke risk and death rates after carotid endarterectomy (CEA) for severe symptomatic or asymptomatic carotid disease in patients aged 80 or more, by comparison with the outcome of CAS reported in the recently- published literature.


METHODS
A retrospective review was conducted on a prospectively compiled computerized database of all primary CEAs performed by a single surgeon at our institution from 1990 to 2003. Descriptive demographic data, risk factors, surgical details, perioperative strokes and deaths, and other complications were recorded.


RESULTS
In all, 1260 CEAs were performed in 1099 patients; 1145 were performed in 987 patients less than 80 years old, and 115 were performed in 112 patients aged 80 or more. There were 11 perioperative strokes in the 1145 procedures in the younger group, for a stroke rate of 0.8%, and no strokes in the 115 procedures in the older group. The death rates were 0% for the octogenarians and 0.3% for the younger group.


CONCLUSIONS
The conviction that older age means higher risk needs to be revised. Patients aged 80 or more can undergo CEA with no more perioperative risks than younger patients. Proponents of CAS should bear this in mind before recommending CAS as the best therapeutic option for such patients.
Department of Surgical & Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy. enzo.ballotta@unipd.it
Enzo
E
Ballotta
Giuseppe
G
Da Giau
Carmelo
C
Militello
Bruno
B
Barbon
Aldo
A
De Rossi
Giorgio
G
Meneghetti
Claudio
C
Baracchini
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000453:epidemiology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome