Carotid endarterectomy in the very elderly: is it worthwhile?

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.