Carotid endarterectomy in elderly patients

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Neurology

Background:

• Symptomatic carotid occlusive disease poses a risk for stroke.
• Elderly patients represent a growing population undergoing surgical interventions.
• The safety and efficacy of carotid endarterectomy in older adults require careful evaluation.

Purpose of the Study:

• To assess the perioperative morbidity and mortality of carotid endarterectomy in patients over 70 years old.
• To evaluate the safety of carotid endarterectomy in selected elderly individuals with symptomatic carotid occlusive disease.

Main Methods:

• Retrospective review of 749 carotid endarterectomies performed between 1971 and 1989.
• Patients were stratified into two age groups: 71-80 years and 81-90 years.
• Analysis of neurologic morbidity and perioperative mortality rates for each group.

Main Results:

• Overall neurologic morbidity was 3.1% and mortality was 1.3% for all patients.
• Neurologic morbidity was 2.9% and mortality 1.4% in patients aged 71-80.
• Neurologic morbidity was 5.4% and mortality 0% in patients aged 81-90.
• Most postoperative neurologic deficits occurred in high-risk patients and were minor.

Conclusions:

• Carotid endarterectomy is a safe procedure for selected elderly patients (over 70) with symptomatic, hemodynamically significant carotid occlusive disease.
• The procedure is associated with acceptably low perioperative morbidity and mortality in this demographic.
• Risk stratification is important, as most deficits occurred in high-risk individuals.