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Carotid endarterectomy in patients less than 50 years old
G H Martin1, R C Allen, B L Noel
1Department of General Surgery, Baylor University Medical Center, USA.
Insights
Carotid endarterectomy (CEA) is safe and effective for young patients with premature atherosclerosis, showing similar outcomes to older patients. Early detection and intervention for carotid occlusive disease in younger individuals are crucial.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Premature atherosclerosis affects younger populations, necessitating evaluation of surgical interventions.
- Carotid endarterectomy (CEA) is a standard procedure for preventing stroke in patients with carotid artery disease.
Purpose of the Study:
- To compare the outcomes of CEA in young patients (<50 years) with premature atherosclerosis against an older control group (>55 years).
- To analyze perioperative complications, long-term outcomes, and survival rates following CEA in distinct age cohorts.
Main Methods:
- Retrospective analysis of 26 patients (<50 years) and 30 patients (>55 years) who underwent CEA.
- Data collected included demographics, risk factors, perioperative events, restenosis, symptoms, stroke, and survival.
Main Results:
- Younger patients had higher rates of smoking (92% vs 70%) and symptomatic presentation (92% vs 57%).
- Perioperative mortality (0%) and morbidity (0-3%) were low in both groups.
- No significant differences were observed in survival rates, late stroke, restenosis, recurrent symptoms, or reoperation rates between young and older patients during a mean follow-up of 67 months.
Conclusions:
- CEA is a safe and effective procedure for young patients with premature carotid occlusive disease.
- Outcomes, including restenosis and stroke risk, are comparable to older patients undergoing CEA.
- Serial duplex ultrasound and timely reoperation can mitigate risks associated with restenosis and prevent late strokes.
Purpose:
The purpose of this study was to compare the results of carotid endarterectomy (CEA) in a young population with premature atherosclerosis with the results of an older control group, examining perioperative morbidity and mortality data, recurrent stenosis and symptoms, late stroke, and survival data.
Methods:
We retrospectively studied 26 patients less than 50 years old (mean, 43.2 +/- 3.8 years) and 30 patients greater than 55 years old (mean, 69.1 +/- 7.4 years) who underwent CEA during the same time period. Data were obtained regarding demographics, atherosclerotic risk factors, indication for CEA, perioperative complications, recurrent stenosis and symptoms, late stroke, and survival.
Results:
Smoking was more prevalent among young patients who underwent CEA (92% vs 70%; p = 0.036). Young patients were also more likely to be symptomatic at presentation (92% vs 57%; p = 0.003). The perioperative mortality rate (0% vs 0%) and neurologic morbidity rate (0% vs 3%; p = 1.000) were low for the study patients. During a mean follow-up of 67 +/- 42.7 months, there was no significant difference in survival rate (5-year survival rate, 93% vs 81%; p = 0.373), rate of late ipsilateral (4% vs 3%) and contralateral (4% vs 3%) stroke, restenosis and occlusion (26.9% vs 14.3%), recurrent symptoms (22% vs 17%), reoperation (11.5% vs 5.7%), or contralateral disease (17% vs 23%) development that required surgery for the study or the control cohorts.
Conclusions:
Our data show that there is a high incidence of smoking and symptomatic presentation among young patients in whom carotid occlusive disease develops. CEA may be performed in young patients with low perioperative morbidity and mortality rates. Recurrent disease, late stroke, and survival rates are not significantly different than for older patients. Follow-up with serial duplex ultrasound and reoperation for symptomatic and high-grade asymptomatic restenosis may decrease the risk of late stroke.