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Carotid endarterectomy in nonagenarians
Quentin J Durward1, Thorir S Ragnarsson, Ralph F Reeder
1Center for Neurosciences, Orthopaedics & Spine PC, Dakota Dunes, SD 57049, USA. quentin.durward@cnos.net
Archives of Surgery (Chicago, Ill. : 1960)
|July 21, 2005
Summary
Carotid endarterectomy (CEA) is safe and effective for patients 89 and older with symptomatic carotid stenosis. This study found no perioperative complications in 26 nonagenarian patients undergoing CEA.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Geriatric Medicine
Background:
- Previous trials showed greater benefit from carotid endarterectomy (CEA) in elderly patients.
- No patients older than 89 years were included in prior major CEA studies.
- The safety and efficacy of CEA in nonagenarians remain under-explored.
Purpose of the Study:
- To evaluate the safety and effectiveness of carotid endarterectomy (CEA) in patients aged 89 years and older.
- To test the hypothesis that CEA is a viable option for nonagenarian patients with symptomatic carotid stenosis.
Main Methods:
- Retrospective review of 30 carotid endarterectomies (CEAs) performed on 26 patients aged 89 years or older.
- Patients had symptomatic high-grade carotid stenosis, with some undergoing staged bilateral CEA.
- Procedures involved general anesthesia with electroencephalographic/transcranial Doppler monitoring and burst suppression for cerebral protection.
Main Results:
- Technical difficulties were noted, but no perioperative cerebral ischemic or cardiac events occurred.
- The mean hospital stay was 2 days.
- Twenty-two patients were alive and well at 24 months; four died of non-stroke-related causes.
Conclusions:
- Carotid endarterectomy (CEA) can be successfully performed in nonagenarian patients without perioperative complications.
- CEA should be considered for medically fit nonagenarian patients with high-grade symptomatic carotid stenosis.
- Recommendations for asymptomatic disease in this age group require further investigation.