[Carotid stenosis in elderly patients]

Carotid stenosis -- a frequent finding in elderly patients -- is associated with an increase risk not only of ipsilateral ischemic stroke, but also of cerebrovascular events in other territories and non neurological vascular events. Prevention of those vascular events is mainly based on optimization of vascular risk factor treatment and antiplatelet therapy. The risk of ipsilateral stroke depends on several predictive factors but the main predictors are a previous ischemic stroke in the carotid stenosis territory and the degree of carotid stenosis. It is recommended that patients who experience non disabling ischemic stroke or transient ischemic attack related to a 70 to 99% carotid stenosis should undergo carotid endarterectomy In patients with moderate symptomatic stenosis (between 50 to 69%), the decision to operate is more difficut because the benefit of carotid endarterectomy is less important. Males, 75 year-old and older are more likely to benefit, particularly when carotid endarterectomy is performed within 2 weeks of the symptoms. In patients with asymptomatic stenosis, the benefit of carotid endarterectomy is highly debated, in particular because the risk of stroke in non-operated patients has fallen over the last decades due to advances in medical therapy Selection of asymptomatic patients for carotid endarterectomy should be guided by an assessment of several factors including comorbid conditions, life expectancy, and age.