Is carotid artery stenting in octogenarians really dangerous?
OBJECTIVE
To evaluate (1) whether carotid artery stenting (CAS) performed in octogenarians increases the procedure-related risk and (2) the incidence of complex anatomy of the aortic arch and supra-aortic vessels in patients >80 years old, which can increase the technical difficulty of CAS.


METHODS
Between December 2000 and September 2005, 1053 patients (903 men; mean age 72+/-2.2 years, range 46-90) underwent 1222 CAS procedures in 2 centers for de novo (n=1192) and restenotic (n=30) lesions (139 staged bilateral procedures). Indications for treatment were the presence of a symptomatic carotid artery stenosis >/=70% (n=798, 65.3%) or an asymptomatic stenosis of at least 80%. The patients were separated into 2 age categories: under 80 (n=1078 procedures, 88.2%) and 80 or older (n=144 procedures, 11.8%) for this analysis. Data analysis included death and stroke rate at discharge and at 30 days. Anatomical characteristics evaluated were aortic arch elongation, arch and supra-aortic vessel calcification and tortuosity, anatomical tortuosity of the lesion, and carotid plaque composition.


RESULTS
Three lesions in octogenarians could not be treated because of failure to access the vessel in 1 case and extremely tortuous arteries in 2. The overall death and stroke rate at 30 days was 2.12% in the older group (2 fatal strokes, 1 minor stroke) and 1.11% in the younger group (3 deaths, 3 major strokes, 6 minor strokes); the difference was not statistically significant (p=0.40). Significantly higher frequencies of tortuosity and calcification of the arch and supra-aortic vessels and of type III aortic arch were observed in the older group (p<0.001).


CONCLUSIONS
In our experience, CAS has proven to be safe and effective in elderly patients. Different age-related anatomical features can represent an adjunctive technical challenge, but these difficulties can be successfully managed without increased perioperative risk if CAS is performed in high-volume centers by highly skilled operators.
Setacci
Carlo
C
Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Italy.
de Donato
Gianmarco
G
Chisci
Emiliano
E
Setacci
Francesco
F
Pieraccini
Massimo
M
Cappelli
Alessandro
A
Palasciano
Giancarlo
G
Castriota
Fausto
F
Cremonesi
Alberto
A
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001013:Aorta, Thoracic / Q000033:anatomy & histology / Q000473:pathology; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000473:pathology; D016893:Carotid Stenosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology*; D016896:Treatment Outcome