[Surgical therapy of cerebrovascular insufficiency with reference to advanced age]

After brief discussion of epidemiology, aetiology, localization, diagnosis and surgical management of vascular stenoses leading to cerebral insufficiency, the results of 433 carotid artery TEAs are reported. Short- and long-term results were investigated to determine to what extent age of the patients affects outcome. The analysis of our patients sample showed with respect to perioperative mortality, morbidity and long-term outcome no significant difference between the under- and over-70-year age groups. In stage I (asymptomatic bruits) the perioperative mortality of the younger group (N = 119) was 1% and in the older group no perioperative death occurred. The long-term survival rate and the proportion of patients without neurological dysfunction after 4 years was 65% and 85% respectively for the younger group and 88% and 80% for the over 70-year age group. In stage II patients (with transient ischaemic attacks) the perioperative mortality was the same for both groups (2%). The long-term survival rate for the younger group (N = 106) was 77% and 76% in the older group (N = 91) proportion of patients without neurological dysfunction was 87% for the younger group and 93% for the older patient sample. There were no patients with stage III occlusion (acute stroke) in our patient sample. In stage IV (completed stroke) the younger patients had a perioperative mortality of 5.7%. In the older group (N = 18) no patient died perioperatively. The 2-year survival rates were 61% for the older age group and 57% für the younger. The corresponding proportions of patients without neurological dysfunction after 4 years were 83% and 71% for the older and younger patient groups respectively.