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Carotid Endarterectomy Outcomes in the Elderly: A Canadian Institutional Experience
Robert James Doonan1, Abdullah Abdullah1, Samantha Steinmetz-Wood1
1Division of Vascular Surgery, McGill University Health Centre, Montreal, Canada.
Insights
Carotid endarterectomy (CEA) is safe for elderly patients regarding stroke and death risks. However, older patients experience longer hospital stays and increased myocardial infarction (MI) risk post-surgery.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Stroke Prevention
Background:
- Carotid endarterectomy (CEA) is a standard procedure for preventing strokes in patients with carotid stenosis.
- Assessing CEA risks in elderly patients is complex due to comorbidities and shorter life expectancy.
- Existing research on CEA outcomes in the elderly is conflicting.
Purpose of the Study:
- To compare the outcomes of CEA between elderly (≥80 years) and younger (<80 years) patients.
- To evaluate the safety and efficacy of CEA in different age groups.
Main Methods:
- Retrospective review of hospital records for consecutive CEA patients from October 2009 to December 2015.
- Primary outcomes: ipsilateral stroke, death, and restenosis at 30 days and 1 year.
- Secondary outcomes: cranial nerve injury, myocardial infarction (MI), hematoma, wound infection, cerebral hyperperfusion, and transient ischemic attacks within 30 days.
Main Results:
- No significant difference in 30-day or 1-year stroke or death rates between elderly and younger patients.
- Elderly patients had a significantly longer postoperative length of stay (2.8 vs. 1.6 days).
- Elderly patients had a significantly higher risk of postoperative myocardial infarction (MI) (4.6% vs. 0.7%).
Conclusions:
- CEA in elderly patients does not increase the risk of stroke or death up to one year postoperatively.
- Increased postoperative length of stay and higher MI rates in the elderly warrant careful consideration in surgical decision-making.
- CEA remains a viable option for stroke prevention in the elderly, with careful risk-benefit assessment.
Background:
Carotid endarterectomy (CEA) is a well-established surgical intervention for stroke prevention in patients with carotid stenosis of all ages. However, the decision to proceed to operate in the elderly involves a more complicated risk-benefit assessment due in part to increased comorbidities and reduced life expectancy. Some studies suggest that CEA is more risky in the elderly with worse outcomes, whereas others have found no difference. Our objective was to evaluate and compare outcomes of CEA between elderly and younger patients at our institution.
Methods:
All hospital charts were reviewed for consecutive patients undergoing CEA from the Jewish General Hospital and the Royal Victoria Hospital from October 2009 to December 2015. Primary outcomes were ipsilateral stroke, death, and restenosis at 30 days and 1 year. Secondary outcomes were cranial nerve injury, myocardial infarction (MI), hematoma, wound infection, cerebral hyperperfusion, and transient ischemic attacks within 30 days. Primary and secondary outcomes were compared between patients aged ≥80 years and <80 years.
Results:
A total of 361 patients were included in this study with a mean age of 70.2 ± 9.5 years (n = 247 [68.4%] male and n = 272 [75.8%] symptomatic). Elderly patients were more often symptomatic (93.8% vs. 71.6%, P < 0.0001) and had an increased length of stay (2.8 ± 5.3 vs. 1.6 ± 1.8, P = 0.001). There was no statistically significant difference in primary outcomes between patients aged <80 years and ≥80 years, including 30-day stroke (1.7% vs. 0%), death (no deaths in either group), restenosis (8.8% vs. 12.3%), 1-year stroke (1.7% vs. 0%), death (0.7% vs. 0%), or restenosis (14.9% vs. 13.8%). However, elderly patients had significantly increased MI risk postoperatively (4.6% vs. 0.7%, P = 0.01). Other complications, including cranial nerve injury (3.7% in <80 years vs. 4.6% in the elderly group), were similar between the groups.
Conclusions:
We found that CEA in the elderly does not have an increased risk of stroke or death up to one year postoperatively. However, the postoperative length of stay is increased and complicated by significantly more MIs, which should weigh into the decision of whether to perform CEA on an elderly patient.
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