Carotid endarterectomy in the elderly patient

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Neurology

Background:

• Elderly patients (>75 years) are at high risk for cerebral ischemic events.
• Hesitancy exists regarding carotid revascularization in this age group due to perceived perioperative risks.

Purpose of the Study:

• To evaluate the safety and efficacy of carotid endarterectomy in patients over 75 years old.
• To compare perioperative outcomes and long-term survival in elderly versus younger patients undergoing carotid endarterectomy.

Main Methods:

• Retrospective analysis of 470 carotid endarterectomies over 54 months.
• Comparison of perioperative morbidity and mortality between patients >75 years and <75 years.
• Long-term follow-up (30 days to 5 years) for elderly patients.

Main Results:

• No significant difference in perioperative stroke (3.9% vs 3.1%) or mortality (0% vs 0.5%) between age groups.
• Three- and five-year survival rates for elderly patients were 78% and 60%, respectively.
• No strokes occurred during follow-up; recurrent symptoms developed in 18% of elderly patients, varying by symptom type.

Conclusions:

• Carotid endarterectomy demonstrates low perioperative morbidity and mortality in elderly patients (>75 years).
• The procedure is justified for significant carotid lesions in the elderly, offering favorable long-term survival.
• Preoperative symptom category influences the risk of recurrent symptoms in elderly patients post-procedure.