Considerations for carotid artery disease management in a frail population

Area of Science:

• Vascular Surgery
• Geriatrics
• Interventional Cardiology

Background:

• Carotid artery stenosis is common in older adults, with treatment options including medical therapy and revascularization (CEA, CAS, TCAR).
• The benefit of revascularization in asymptomatic patients with carotid artery stenosis remains uncertain.
• Minimally invasive techniques expand revascularization candidacy, but procedural risks persist, especially in older adults with comorbidities.

Purpose of the Study:

• To review the management of carotid artery stenosis in older adults.
• To explore the relationship between frailty and carotid artery stenosis treatment decisions.
• To discuss integrating frailty assessment into shared decision-making for optimal patient care.

Main Methods:

• Literature review on carotid artery stenosis management in older adults.
• Analysis of the role of frailty assessment in clinical decision-making.
• Discussion of shared decision-making models incorporating frailty.

Main Results:

• Frailty assessment can identify older adults who may not benefit from or tolerate revascularization procedures.
• Integrating frailty into shared decision-making enhances personalized treatment planning for carotid artery stenosis.
• Novel revascularization techniques offer options but require careful risk-benefit analysis, particularly in frail individuals.

Conclusions:

• Frailty assessment is a valuable tool for guiding treatment decisions in older adults with carotid artery stenosis.
• Shared decision-making, informed by frailty, is crucial for optimizing outcomes in this patient group.
• Personalized management strategies are essential, considering both stenosis severity and patient-specific factors like frailty.