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Entering the ninth decade is not a contraindication for carotid endarterectomy
J J Hoballah1, M M Nazzal, C Jacobovicz
1Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City 52242-1086, USA.
Insights
Carotid endarterectomy (CEA) is safe for octogenarians when properly selected. This study found low perioperative complication rates and acceptable long-term outcomes, suggesting age alone should not preclude CEA for stroke prevention.
Area of Science:
- Vascular Surgery
- Neurology
- Geriatric Medicine
Background:
- Carotid endarterectomy (CEA) is established for stroke prevention.
- Its efficacy and safety in patients over 79 years old remain controversial due to limited trial data.
Purpose of the Study:
- To evaluate the safety and outcomes of CEA in patients aged 79 years and older.
- To determine if advanced age alone is a contraindication for CEA.
Main Methods:
- Retrospective review of 41 patients over 79 years old who underwent CEA between January 1988 and December 1996.
- Analysis of indications, medical risk factors, anesthetic techniques, and perioperative/follow-up outcomes.
Main Results:
- Low perioperative stroke (2.4%) and myocardial infarction (2.4%) rates were observed.
- No 30-day mortality; average hospital stay was 3.4 days.
- During a mean follow-up of 20.7 months, six deaths occurred (4 MI, 2 stroke).
Conclusions:
- CEA is a safe procedure in carefully selected octogenarian patients.
- Patient selection, not age alone, should guide the decision for CEA.
Abstract:
The role of carotid endarterectomy (CEA) in stroke prevention is now better defined. However, its role in patients older than 79 years of age is controversial. This group of patients has been excluded in most clinical trials. In this study the authors reviewed their experience with CEA patients >79 years old. The records of all patients older than 79 years of age who underwent a CEA in a recent time period from January 1988 to December 1996 were retrospectively reviewed. Forty-one patients (31 men, 10 women) were identified by computer search. The indication for operation included transient ischemic attack in 12 (29.3%), amaurosis fugax in nine (22%), stroke in two (4.9%), and nonhemispheric symptoms in three (7.3%). Fifteen patients (36.6%) were asymptomatic. Medical risk factors included coronary artery disease in 26 (63.4%), hypertension in 22 (53.7%), and smoking in 12 (29.3%). The procedure was performed under EEG monitoring in all patients. General anesthesia was administered in 37 (90%) and regional anesthesia in four (10%). Shunts were used in four (10%) patients. The internal carotid artery was patched in 16 patients (39%). One patient (2.4%) developed a perioperative stroke and only one patient developed perioperative myocardial infarction (MI). None of the patients died within 30 days of surgery. In addition to the one MI case, five patients developed minor complications. The average length of time for stay after CEA was 3.4 days. Patients were followed up for an average of 20.7 months. Six patients died during follow-up. Four of those died from an MI and two from a stroke. The authors conclude that with proper selection of patients, CEA is safe in the octogenarian. Age alone should not be a contraindication for CEA.