title: Carotid endarterectomy as the criterion standard in high-risk elderly patients.
abstract: BACKGROUND
  Carotid angioplasty and stenting (CAS) is now a viable alternative to carotid endarterectomy (CEA) in patients considered to be high-risk candidates for surgery, despite recent reports of increased adverse periprocedural outcomes in elderly patients. We sought to evaluate our single-institution experience and the 30-day perioperative outcomes of CEA in patients 75 years or older, who are traditionally considered high-risk surgical candidates and are recommended for CAS.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  All patients 75 years or older undergoing CEA during a 16-year period.
  
  
  METHODS
  Primary outcome of 30-day perioperative stroke, death, or myocardial infarction (MI) and a composite outcome of stroke, death, or MI. Secondary outcomes of all perioperative complications were exclusive of primary outcomes.
  
  
  RESULTS
  One hundred seventeen CEAs were performed in 110 patients 75 years or older. Significant medical comorbidities were well represented among the group. Among the patients, 50.4% were symptomatic, 60.7% had greater than 90% carotid stenosis, and 44.4% had contralateral disease. Primary outcome for any stroke, death, or MI was 1.7%, 0.9%, or 3.4%, respectively, with a composite event rate of any stroke or death of 2.6%. One or more secondary outcomes were experienced by 26.5% of patients.
  
  
  CONCLUSIONS
  Carotid endarterectomy in elderly patients with significant comorbidities, traditionally thought to be a high-risk undertaking, is a safe procedure with periprocedural risks of stroke, death, and MI equivalent to those of younger patients. In light of the increased stroke risk in elderly patients with CAS, CEA remains the criterion standard for prevention of stroke in this patient population.
authors: Section of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, CA 92103-8403, USA.
authors: Ahmed
authors: A
authors: Suliman
authors: Joshua
authors: J
authors: Greenberg
authors: Ankur
authors: A
authors: Chandra
authors: Samuel
authors: S
authors: Barillas
authors: Pooya
authors: P
authors: Iranpour
authors: Niren
authors: N
authors: Angle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies