Internal carotid artery stenting in patients over 80 years of age: single-center experience and review of the literature.
BACKGROUND
Thirty percent to 40% of strokes in the elderly are secondary to carotid bifurcation disease. The treatment of internal carotid artery (ICA) stenosis in this patient population is a clinical dilemma. Age more than 80 years is a risk factor for carotid endarterectomy (CEA). Carotid artery stenting (CAS) may be also associated with increased peri-procedural complications in this age group.


METHODS
This study was a single-center, retrospective database analysis evaluating CAS in patients more than 80 years old. Primary outcome included death, myocardial infarction (MI), or ipsilateral stroke. Secondary outcome included re-stenosis at 30 days, 6 months, and 1-year post-procedure.


RESULTS
Between March 2001 and March 2004, CAS was performed in 178 patients. Twenty-four patients were more than 80 years old (range 80-91), and 16 men, 70.8%, were symptomatic. Success rate was 100% with residual stenosis of <20%. At the 30 days follow-up there was 1 non-Q wave MI (4.2%), 1 transitory ischemic attack (TIA), and 1 femoral occlusion in the symptomatic group. There were no deaths at 1-year follow-up evaluation as well as no ICA re-stenosis.


CONCLUSIONS
CAS can be performed in patients more than 80 years old. Complications may be higher than in younger patients. However, because of the high prevalence of stroke in octogenarians, randomized trials should include this patient population.
Linfante
Italo
I
Section of Endovascular Neurosurgery, Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA. italol@baptisthealth.net
Andreone
Vincenzo
V
Akkawi
Nabil
N
Wakhloo
Ajay K
AK
D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D016491:Peripheral Vascular Diseases / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome