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Carotid endarterectomy in the very elderly: is it worthwhile?
1Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD.
Insights
Carotid endarterectomy is safe for elderly patients over 75, showing low operative risk and excellent long-term stroke prevention. This procedure offers significant benefits for reducing stroke incidence in this vulnerable population.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Neurology
Background:
- Stroke is a leading cause of death, with incidence and mortality increasing with age.
- Carotid artery arteriosclerosis is a primary cause of stroke.
- Carotid endarterectomy reduces stroke incidence, but its use in the very elderly is debated due to perceived risks.
Purpose of the Study:
- To evaluate the short-term risks and long-term outcomes of carotid endarterectomy in patients aged 75 years and older.
- To assess operative mortality, stroke, and major complications in this elderly cohort.
- To determine long-term stroke-free survival and overall survival rates.
Main Methods:
- Retrospective review of 63 carotid endarterectomies in 59 patients aged 75+ over 12 years.
- Analysis of operative mortality, perioperative stroke, and major cardiac complications.
- Long-term follow-up (1-122 months) for stroke-free and overall survival.
Main Results:
- Zero operative deaths and a 4.8% perioperative stroke rate.
- Major cardiac complications occurred in 7.9% of patients.
- 5-year stroke-free survival was 68%, and 10-year survival was 42%; 5-year overall survival was 80% and 10-year survival was 52%.
Conclusions:
- Carotid endarterectomy is associated with low operative risk in very elderly patients.
- The procedure yields excellent long-term results, including reduced stroke incidence and improved survival.
- This intervention is a viable and beneficial option for stroke prevention in geriatric populations.
Background:
Stroke continues to be the third leading cause of death in this country, its incidence and corresponding mortality rate increase with age, and in the majority of cases it results from arteriosclerosis of the carotid artery. Although recent studies have clearly shown the benefit of carotid endarterectomy in reducing the incidence of stroke, performance of this procedure in very elderly patients, the patient population for whom it should be most beneficial, has been challenged by some investigators on the basis of perceived increased operative risk.
Methods:
The records of all carotid endarterectomies (n = 63) performed during the last 12 years for all patients (n = 59) with a minimum age of 75 years were reviewed to define the short-term risk of operative mortality, stroke and other major complications, and the long-term outcome.
Results:
No (0%) operative deaths and three (4.8%) perioperative strokes occurred. Major cardiac complications occurred in five cases (7.9%). Follow-up, ranging from 1 to 122 months (mean, 27.4 months), was available for 54 patients (91.5%). Cumulative freedom from stroke was 92% at 2 years and 80% at 5 and 10 years of follow-up. Long-term survival rate was 80% at 5 years and 52% at 10 years, and stroke-free survival rate was 68% at 5 years and 42% at 10 years of follow-up.
Conclusions:
Carotid endarterectomy can be performed in very elderly patients with low operative risk and excellent long-term results.