Carotid endarterectomy in octogenarians: does increased age indicate "high risk?"

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Cardiovascular Disease

Background:

• Carotid endarterectomy (CEA) is a standard treatment for carotid artery stenosis.
• Patients aged 80 and older are often excluded from trials due to perceived high risk.
• Advanced age is frequently considered a contraindication for CEA.

Purpose of the Study:

• To evaluate the safety and efficacy of CEA in patients aged 80 years and older.
• To determine if advanced age correlates with increased morbidity, mortality, or length of stay after CEA.
• To challenge the arbitrary classification of octogenarians as
• high-risk

Main Methods:

• Analysis of 2217 CEAs performed between 1993 and 2004.
• Comparison of outcomes between 334 patients aged 80+ and a younger cohort.
• Review and summarization of contemporary literature on CEA in octogenarians.

Main Results:

• No significant difference in stroke rates between octogenarians and younger patients (1.1% vs 0.8%).
• Higher operative mortality (1.9% vs 0.8%) and combined stroke/death rates (3.1% vs 1.5%) in octogenarians, particularly symptomatic ones.
• Longer postoperative length of stay for octogenarians, with a higher percentage hospitalized beyond 5 days.

Conclusions:

• CEA is a safe and effective procedure for octogenarians.
• Increased combined stroke/death risk in octogenarians, especially symptomatic ones, warrants careful consideration.
• Outcomes for octogenarians undergoing CEA are within acceptable national guidelines, refuting the automatic
• high-risk
• designation based solely on age.