[Carotid surgery in patients 80 years old or older]
H H Eckstein1, T Weiss, T Böser
1Gefässchirurgische Klinik, Klinikum Ludwigsburg.
Insights
Carotid endarterectomy (TEA) is safe for patients 80 and older, despite co-morbidities. This study found low rates of stroke and death, indicating TEA is a viable option for this age group.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Neurology
Context:
- Elderly patients (80+) face higher risks of ischemic stroke.
- Physicians often hesitate to perform carotid endarterectomy (TEA) in this demographic due to age and co-morbidities.
- This study addresses the safety and outcomes of TEA in octogenarians.
Purpose:
- To evaluate the morbidity and mortality rates of carotid endarterectomy (TEA) in patients aged 80 years and older.
- To assess the safety of performing TEA in a high-risk geriatric population.
- To provide data supporting or refuting the cautious approach to TEA in the very elderly.
Summary:
- A prospective study analyzed 46 carotid endarterectomies (TEA) performed on patients 80+ between 1994-1998.
- Outcomes included a 2.2% perioperative stroke rate, 0% mortality, and 6.5% transient neurological deficits.
- Complications were generally minor, with one case of carotid artery thrombosis requiring reoperation.
Impact:
- Demonstrates that carotid endarterectomy (TEA) can be performed with significant safety in patients aged 80 and above.
- Challenges the notion that advanced age alone is an absolute contraindication for stroke prevention via TEA.
- Provides evidence for reconsidering TEA indications in the elderly population at high risk for cerebrovascular accidents.
Background And Objective:
Because of their high age and markedly increased co-morbidity, physicians and geriatricians are often cautious in their indications for carotid thromboendarterectomy (TEA) in patients 80 years or older. However, it is these very patients who are subject to an exponentially increased risk of ischaemic cerebral vascular accidents (CVA). This study examined the morbidity and mortality rates of TEA in patients of this age group at one institution.
Patients And Methods:
Between 1994 and 1998, among a total of 912 TEAs, 46 had been performed in patients 80 years or older (15 women, 31 men): indications, diagnosis and associated diseases as well as perioperative complications were entered prospectively into a data-bank.
Results:
Only one patient (2.2%) sustained a perioperative CVA and no patient died. Three patients (6.5%) developed transitory neurological deficits. One patient had to have an emergency reoperation because of a postoperative carotid artery thrombosis. One patient had an intraoperative asystole due to a hypersensitive carotid sinus. There were no other serious cardiovascular or pulmonary complications. One patient sustained some oral muscle weakness as a result of intraoperative retractor pull on a branch of the facial muscle.
Conclusion:
These results indicate that even in patients of this age group carotid TEA can be performed with great safety.
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