title: Carotid artery stenting in nonagenarians: are there benefits in surgically treating this high risk population?
abstract: BACKGROUND
  Carotid angioplasty and stenting (CAS) is considered desirable treatment for patients at high risk for carotid endarterectomy. Despite a growing elderly population, scant data exist on CAS in nonagenarians. Nonagenarians represent a high risk population for open and endovascular interventions due to unique anatomic and physiologic characteristics presenting significant challenges to anesthesiologists and surgeons. Studies have quantified that symptomatic and asymptomatic patients should survive 2 and 5 years, respectively, to gain benefit from revascularization; thus doubt exists on the value of CAS in nonagenarian patients because of their extreme age and unique risk factors. We therefore evaluated CAS safety and efficacy in our hospital's nonagenarian population.
  
  
  METHODS
  CAS cases performed in patients aged ≥ 90 years between April 2005 and January 2013 were retrospectively examined. Relevant demographic and medical data were reviewed. Rates of perioperative complications and complications until end of follow-up (including stroke, myocardial infarction, death) were compiled.
  
  
  RESULTS
  Among 21 nonagenarian cases of stent placement performed in 20 patients (11 symptomatic, nine asymptomatic), two patients suffered perioperative stroke after undergoing CAS and one died during the perioperative period. 50% of symptomatic patients were alive at 19 months; 50% of asymptomatic patients were alive at 47 months.
  
  
  CONCLUSIONS
  CAS in nonagenarian patients carried increased risk of perioperative ischemic events, compared with contemporary trial results in symptomatic and asymptomatic patients. Further, mean survival time postprocedure fell short of guidelines for receiving procedural benefit. Although larger scale multicenter research is needed, we recommend careful consideration of overall health status when contemplating stenting in nonagenarians.
authors: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Michael M
authors: MM
authors: Wach
authors: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Travis M
authors: TM
authors: Dumont
authors: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Hakeem J
authors: HJ
authors: Shakir
authors: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors: Kenneth V
authors: KV
authors: Snyder
authors: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA.
authors: L Nelson
authors: LN
authors: Hopkins
authors: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors: Elad I
authors: EI
authors: Levy
authors: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA.
authors: Adnan H
authors: AH
authors: Siddiqui
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000401:mortality* / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Complication; Stenosis; Stent