title: Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly.
abstract: OBJECTIVE
  Uncertainty exists about the influence of advanced age on the outcomes of carotid revascularization.
  
  
  OBJECTIVE
  To undertake a comprehensive review of the literature and conduct an analysis of the outcomes of carotid interventions in the elderly.
  
  
  METHODS
  A systematic literature review was conducted to identify articles comparing early outcomes of carotid endarterectomy (CEA) or carotid stenting (CAS) in elderly and young patients.
  
  
  METHODS
  Combined overall effect sizes were calculated using fixed or random effects models. Meta-regression models were formed to explore potential heterogeneity as a result of changes in practice over time. RESULTS Our analysis comprised 44 studies reporting data on 512,685 CEA and 75,201 CAS procedures. Carotid stenting was associated with increased incidence of stroke in elderly patients compared with their young counterparts (odds ratio [OR], 1.56; 95% CI, 1.40-1.75), whereas CEA had equivalent cerebrovascular outcomes in old and young age groups (OR, 0.94; 95% CI, 0.88-0.99). Carotid stenting had similar peri-interventional mortality risks in old and young patients (OR, 0.86; 95% CI, 0.72-1.03), whereas CEA was associated with heightened mortality in elderly patients (OR, 1.62; 95% CI, 1.47-1.77). The incidence of myocardial infarction was increased in patients of advanced age in both CEA and CAS (OR, 1.64; 95% CI, 1.57-1.72 and OR, 1.30; 95% CI, 1.16-1.45, respectively). Meta-regression analyses revealed a significant effect of publication date on peri-interventional stroke (P = .003) and mortality (P < .001) in CAS.
  
  
  CONCLUSIONS
  Age should be considered when planning a carotid intervention. Carotid stenting has an increased risk of adverse cerebrovascular events in elderly patients but mortality equivalent to younger patients. Carotid endarterectomy is associated with similar neurologic outcomes in elderly and young patients, at the expense of increased mortality.
authors.affiliation: Department of Vascular Surgery, Hellenic Red Cross Hospital, Athens, Greece2Department of Vascular and Endovascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: Department of Vascular and Endovascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Georgiadis
authors.affiliation: Department of Vascular and Endovascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Georgakarakos
authors.affiliation: Department of Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.affiliation: Department of Vascular Surgery, Hellenic Red Cross Hospital, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Bessias
authors.affiliation: Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom.
authors.forename: John Vincent
authors.initials: JV
authors.lastname: Smyth
authors.affiliation: Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Murray
authors.affiliation: Department of Vascular and Endovascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Miltos K
authors.initials: MK
authors.lastname: Lazarides
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D057510:Endovascular Procedures / Q000379:methods / Q000401:mortality*; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography