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Carotid endarterectomy in the elderly
R L Treiman1, W H Wagner, R F Foran
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Insights
Carotid endarterectomy is a safe surgical option for patients 80 years and older. This study found surgical risk in elderly patients undergoing carotid endarterectomy was comparable to younger patients.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Neurology
Background:
- Carotid endarterectomy is a procedure to remove plaque from carotid arteries.
- Surgical risk in elderly patients (80+) is not well-established.
Purpose of the Study:
- To determine the surgical risk of carotid endarterectomy in patients 80 years of age or older.
- To compare the outcomes of carotid endarterectomy in elderly versus younger patients.
Main Methods:
- Retrospective review of 146 patients aged 80+ who underwent 183 carotid endarterectomies between 1964 and 1990.
- Analysis of indications for surgery, including asymptomatic stenosis, transient ischemic attacks, stroke, and retinal emboli.
- Comparison of postoperative stroke and mortality rates with a cohort of patients younger than 80.
Main Results:
- Three patients (1.6%) experienced a stroke with residual deficit postoperatively.
- Three patients (1.6%) died, all from myocardial infarction.
- The combined stroke and death rate in patients 80+ (3.2%) was lower than in patients younger than 80 (3.5%) for similar indications.
Conclusions:
- Carotid endarterectomy is a relatively safe procedure for patients 80 years and older.
- Elderly patients should be considered for carotid endarterectomy based on similar criteria used for younger patients.
- The procedure offers a favorable risk-benefit profile for selected elderly individuals with carotid stenosis.
Abstract:
The records of 146 patients 80 years of age or older who underwent 183 carotid endarterectomy operations from 1964 through 1990 were reviewed to determine surgical risk. The indications for operation were asymptomatic patients with carotid stenosis (n = 36); ipsilateral transient ischemic attacks (n = 46); ipsilateral stroke (n = 28); ipsilateral retinal embolus (n = 15); nonlateralizing symptoms (n = 40); and asymptomatic side in patients with contralateral symptoms (n = 18). Postoperatively, three patients (1.6% of operations) had a stroke with a residual deficit and three (1.6%) died. All deaths were from myocardial infarction. For comparison, during the same time period, the combined stroke with residual deficit and death rate for patients less than 80 operated upon for similar indications was 3.5%. Since 80-year-old patients have a life expectancy of at least five years, the authors conclude that elderly patients should be evaluated for carotid endarterectomy using criteria similar to that used for younger patients.