Carotid endarterectomy under local anesthesia in elderly: is it worthwhile?
B Amato1, A K Markabaoui, V Piscitelli
1Department of General and Geriatric Surgery, University of Naples "Federico II", Naples, Italy.
Acta Bio-Medica : Atenei Parmensis
|February 3, 2006
Summary
Carotid endarterectomy (CEA) is safe for patients over 75. This study shows CEA in elderly patients has low in-hospital mortality, comparable to younger groups, supporting its use in selected older individuals.
Area of Science:
- Vascular Surgery
- Neurology
- Geriatric Medicine
Background:
- Carotid endarterectomy (CEA) improves stroke-free survival but often excludes elderly patients.
- Concerns exist regarding CEA benefits in the elderly, particularly women.
Purpose of the Study:
- To analyze outcomes of CEA in patients aged 80 and older compared to younger counterparts.
- To evaluate the safety and efficacy of CEA in elderly patients (over 75).
Main Methods:
- Retrospective outcome analysis of 262 carotid operations performed under local anesthesia (1998-2004).
- Comparison of 70 patients over 75 years old with younger patients.
- Data collected on patient demographics, comorbidities, presentation, and postoperative complications.
Main Results:
- In-hospital mortality for patients over 75 was 2.9%, not significantly higher than younger patients (1.5%).
- Complications included transient neurological deficit (1), stroke (1), and myocardial infarction (1).
- Local anesthesia facilitated safe CEA in selected patients over 75.
Conclusions:
- Carotid endarterectomy can be safely performed in selected elderly patients (over 75) under local anesthesia.
- Outcomes in this elderly cohort were comparable to younger patients, challenging previous exclusion criteria.
- This supports the consideration of CEA for stroke prevention in appropriately selected older individuals.
