[Carotid thromboendarterectomy in old age]

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Neurology

Background:

• Extracranial internal carotid artery stenosis is a significant risk factor for stroke.
• Carotid bifurcation endarterectomy is a common surgical intervention.
• Patient age is a critical factor in surgical risk assessment.

Purpose of the Study:

• To analyze the outcomes of carotid endarterectomy in relation to patient age.
• To compare anesthetic risk factors, neurological symptoms, and lesion diameter between age groups.
• To evaluate operative mortality and stroke incidence in different age cohorts.

Main Methods:

• Retrospective analysis of 323 carotid endarterectomies and 77 non-operated patients.
• Patients divided into two groups: Group 1 (≤69 years) and Group 2 (≥70 years).
• Comparison of anesthetic risks, neurological symptoms, lesion diameter, operative mortality, and morbidity between groups.

Main Results:

• No significant differences in anesthetic risk factors, neurological symptoms, or lesion diameter between age groups, except for mild stenoses (≤50%).
• Overall operative mortality was 1.8% (1.5% in Group 1, 3.6% in Group 2, not significant).
• Overall neurological morbidity was 0.6%, with both strokes occurring in Group 2 (3.6%). Fatal and non-fatal stroke incidence was significantly higher in Group 2 (7.3%) compared to Group 1 (0.7%, p<0.001).

Conclusions:

• Patients aged 70 years and older undergoing carotid endarterectomy exhibit a significantly higher incidence of stroke.
• While overall mortality may not differ significantly, the increased stroke risk in elderly patients warrants careful consideration.
• Age is a crucial factor in risk stratification for carotid endarterectomy, necessitating tailored perioperative management for older individuals.