Carotid endarterectomy is safe for octogenarians

Area of Science:

• Vascular Surgery
• Neurology
• Geriatrics

Background:

• Carotid endarterectomy (CEA) is a standard procedure for reducing stroke risk in patients with high-grade carotid stenosis.
• The efficacy and safety of CEA in elderly and high-risk populations have been debated.
• This study addresses these concerns using data from a high-volume single institution.

Purpose of the Study:

• To evaluate risk factors for postoperative stroke after CEA.
• To assess stroke-free survival stratified by age in patients undergoing CEA.
• To provide long-term follow-up data for elderly and high-risk patients.

Main Methods:

• Retrospective review of 840 consecutive patients undergoing CEA (2011-2018).
• Primary endpoint: 30-day perioperative stroke.
• Secondary endpoints: late stroke, death, myocardial infarction; comparison of patients aged >80 vs. <80 years.

Main Results:

• Overall 30-day stroke rate was 1.0%, with similar rates in octogenarians (1.5%) versus younger patients (0.8%).
• Hispanic race was a risk factor; White race and statin use were protective.
• Patients aged ≥80 had decreased 5-year stroke-free survival (P=.031), but overall 5-year survival was similar to the general population.

Conclusions:

• Carotid endarterectomy is safe and effective for octogenarians, regardless of symptomatic or asymptomatic status.
• The procedure yields excellent 30-day outcomes and comparable long-term survival to the general population.
• Age alone should not be a contraindication for CEA in selected patients.