title: Safety of Carotid Revascularization in Symptomatic Patients with less than 70 Years.
abstract: BACKGROUND
  Age is a main risk factor for stroke and perioperative risk. This study aims to analyze the effect of age by symptomatic status in young patients receiving carotid revascularization.
  
  
  METHODS
  Consecutive carotid revascularization procedures performed during the period 2001-2009 were reviewed. Patients were analyzed by age using the 70-year threshold as suggested by trials. Primary end point was perioperative stroke or death rate. Secondary end points included survival and late stroke incidence at 6 years.
  
  
  RESULTS
  A total of 2,196 procedures (1,080 by carotid artery stenting [CAS] and 1,116 by carotid endarterectomy [CEA]) were analyzed. Symptomatic patients (n = 684) showed higher perioperative stroke or death risks (24 of 684 [3.5%] versus 29 of 1,512 [1.9%], odds ratio [OR] 1.8; 95% confidence interval [CI] 1.07-3.22; P = 0.034) and lower 6-year survival (74% vs. 82%, P < 0.0001) or freedom from late stroke (93% vs. 97%, P = 0.001) when compared with asymptomatic patients with similar differences detected within CEA or CAS procedure. Overall 949 procedures were in patients with 70 years or less at the time of intervention (500 CEA and 449 CAS); 282 were in patients symptomatic for minor stroke or transient ischemic attack within 6 months before revascularization. For young symptomatic patients, primary end point rates were <2.5% after both CEA and CAS procedure. Perioperative stroke or death rates were 2.4% in symptomatic versus 1.5% in asymptomatic (4 of 170 vs. 5 of 330; OR 1.57; 95% CI 0.42-5.91; P = 0.50) within the CEA group and 1.8% in symptomatic versus 1.2% in asymptomatic (2 of 112 vs. 4 of 337; OR 1.51; 95% CI 0.27-8.38; P = 0.64) within the CAS group. At 6 years, symptomatic young patients showed survival (89.5% vs. 89%, P = 0.76) and freedom from late stroke (97% vs. 98%, P = 0.56) rates comparable to those found in asymptomatic patients, with similar incidences after CAS or CEA procedure.
  
  
  CONCLUSIONS
  Outcomes after carotid revascularization are related to patients' age. At younger ages (<70 years), after carotid revascularization, symptomatic patients show low perioperative risks of stroke or death, comparable with those in asymptomatic patients. The same, 2.5% or lower, threshold for perioperative stroke or death risk related to asymptomatic carotid procedures must be applied today to symptomatic patients when younger than age of 70 years.
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy. Electronic address: plderango@gmail.com.
authors.forename: Paola
authors.initials: P
authors.lastname: De Rango
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
authors.forename: Gioele
authors.initials: G
authors.lastname: Simonte
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Farchioni
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cieri
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Manzone
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
authors.forename: Giovanbattista
authors.initials: G
authors.lastname: Parlani
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lenti
authors.affiliation: Unit of Vascular Surgery, Hospital S. M. Misericordia, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Verzini
mesh_terms: D000367:Age Factors; D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome