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Carotid endarterectomy in symptomatic elderly patients
C M Loftus1, J Biller, J C Godersky
1Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City.
Insights
Carotid endarterectomy in patients over 70 is safe and effective, with no perioperative deaths. This study highlights successful surgical outcomes for elderly individuals undergoing this procedure.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Geriatric Medicine
Background:
- Carotid endarterectomy is a common procedure for stroke prevention.
- Elderly patients (over 70) represent a significant and growing population undergoing this surgery.
- Understanding the specific risks and outcomes in this age group is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the safety and efficacy of carotid endarterectomy in patients aged 70 and older.
- To analyze perioperative outcomes, complications, and risk factors in this specific demographic.
Main Methods:
- Retrospective review of 53 consecutive carotid endarterectomies in patients over 70.
- Analysis of patient demographics, medical history, surgical details, and outcomes.
- Use of electroencephalographic (EEG) monitoring and angiography for patient management.
Main Results:
- No perioperative deaths occurred in the series of 53 elderly patients.
- One postoperative stroke and one nonfatal myocardial infarction were reported.
- Transient complications included wound hematomas, abscess, and cranial nerve palsies (13%).
Conclusions:
- Carotid endarterectomy can be performed with excellent safety and low morbidity in patients over 70.
- Careful patient selection and intraoperative monitoring contribute to successful outcomes in this age group.
- The findings support the continued use of carotid endarterectomy for stroke prevention in the elderly.
Abstract:
Fifty-three of 203 consecutive carotid endarterectomies (26%) performed on the Neurosurgical Service at the University of Iowa were in patients over 70 years of age (mean age, 73.4). This series included 38 men and 15 women. Thirty-three patients (62%) presented with transient ischemic attacks, and the remaining 38% were functional stroke patients. Medical risk factors in this group included hypertension in 70%, previous myocardial infarction in 26%, angina in 17%, peripheral vascular disease in 23%, and diabetes in 13%. Sixty-four per cent of the patients had been previously treated with antihypertensive drugs, 43% with antiplatelet agents, and 4% with anticoagulants. Noninvasive vascular evaluation was performed in 25 of 53 (47%) patients, and all underwent angiography before operation. There were no angiographic complications. All patients were operated on with full-channel electroencephalographic (EEG) monitoring. Indwelling shunts were required in 6 of 53 (11%) cases. Intraoperative heparin was given and not reversed; the mean dose was 5100 units. The mean clamp time was 48 minutes. Patch grafts, fashioned from common facial or saphenous veins, were used in 2 patients. Eight patients had contralateral carotid occlusions, but only 2 (25%) required indwelling shunt placement based on EEG criteria. There were no perioperative deaths in this series. One patient had a postoperative stroke, and 1 patient had a postoperative nonfatal myocardial infarction. Transient surgical complications included 3 wound hematomas, 1 wound abscess, and 2 self-limited cranial nerve palsies (13%).(ABSTRACT TRUNCATED AT 250 WORDS)