Carotid artery stenting in octogenarians is associated with increased adverse outcomes

Stanziale, Stephen F.; Marone, Luke; Boules, Tamer N.; Brimmeier, Judith A.; Hill, Katherine; Makaroun, Michel S.; Wholey, Mark H.

doi:10.1016/j.jvs.2005.10.062

Cited by 92 publications

(63 citation statements)

References 41 publications

(53 reference statements)

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“…Similarly, the 30-day stroke and death rates tended to be higher in older than in younger subjects undergoing protected CAS in this and other single-center studies. 23 Patients with a symptomatic carotid stenosis tended to have more new DWI lesions after unprotected CAS than asymptomatic patients (74% versus 52%; P ϭ .09), indicating that these patients have an increased microembolic risk during this procedure. It is conceivable that the high prevalence of thrombotically active plaques in recently symptomatic patients is the main determinant for this finding 24 and could also serve as an explanation for the increased risk of clinical stroke during CAS in these patients.…”

Section: Discussionmentioning

confidence: 92%

Effects of Age and Symptom Status on Silent Ischemic Lesions after Carotid Stenting with and without the Use of Distal Filter Devices

Kastrup

Gröschel²,

Nägele³

et al. 2007

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 92%

Effects of Age and Symptom Status on Silent Ischemic Lesions after Carotid Stenting with and without the Use of Distal Filter Devices

Kastrup

Gröschel²,

Nägele³

et al. 2007

AJNR Am J Neuroradiol

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“…Many studies have demonstrated extremely high stroke and death rates, between 9.2-25% in the endovascular treatment in patients older than 80 years. [33][34][35] This fact can be due to several factors, such as presence of more extensive atherosclerotic lesions, with higher calcification degree in the bifurcation, associated with presence of ulcers and thrombi. There may also be proximal ostial stenoses, which make catheter passage difficult, or ulcerated lesions at the aortic arch level, which facilitate mobilization of fragment of plaques or thrombi by passing catheters and devices used in carotid angioplasty.…”

Section: Old Agementioning

confidence: 99%

Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Bonamigo

Lucas

2007

J. vasc. bras.

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O tratamento da doença carotídea tem ganhado enfoque nos últimos anos, principalmente com o advento da técnica endovascular, que defende o emprego da angioplastia e stent de carótida (CAS), principalmente em pacientes considerados de "alto risco" para a endarterectomia carotídea (ECA). Através da revisão bibliográfica, analisamos os resultados do tratamento da lesão carotídea em ambas as técnicas, realizando comentários embasados na experiência pessoal e nos dados da literatura, sobretudo nos pacientes de alto risco. Até o presente momento, não há evidência e justificativa para o emprego da CAS em larga escala nos pacientes com doença carotídea, inclusive nas situações de alto risco, tais como nos octogenários. No entanto, acreditamos que a CAS possa ser um coadjuvante no tratamento de pequeno número de pacientes com lesão carotídea (até 4% dos casos), como na presença de pescoço hostil, radioterapia prévia e alguns casos de estenose carotídea alta. Quando realizada com os cuidados técnicos necessários, a ECA ainda continua a melhor opção terapêutica aos doentes com lesão carotídea.

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“…However, some clinical trial data suggest that, similar to CEA, the rate of adverse outcomes increases when CAS is performed in older pa-tients. [7][8][9][10] In both randomized controlled trials and postmarket clinical trials for CAS in high surgical risk patients such as Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE), 11 the initial Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) lead-in phase, 7 CAPTURE, 12 and SAPPHIRE-WW, 13 patients Ն80 years old were included; in these studies, age was identified as a risk factor for adverse perioperative outcomes, including death and stroke, compared with outcomes in younger patients. Paradoxically, several individual institutional studies specifically examining the role of age in CAS outcomes reported no significant difference in adverse outcome rates between octogenarians and nonoctogenarians.…”

Section: S Troke Is the Third Leading Cause Of Death In The Unitedmentioning

confidence: 99%

Carotid Artery Stenting in Octogenarians

Chaturvedi

Matsumura

Gray

et al. 2010

Stroke

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on behalf of the CAPTURE 2 Investigators and Executive Committee Background and Purpose-Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) is an ongoing prospective, nonrandomized, multicenter clinical trial enrolling patients undergoing carotid artery stenting.The aim of this analysis is to identify risk predictors for periprocedural stroke in patients Ն80 years old. Methods-Symptomatic patients with Ն50% stenosis and asymptomatic patients with Ն80% stenosis were enrolled.Patients' neurological status was assessed by an independent neurologist before as well as 24 hours and 30 days postprocedure. All strokes and suspected strokes were adjudicated by an independent committee. Logistic regression analysis was conducted to identify baseline demographic, lesion, procedural, or comorbidity parameters associated with outcomes in patients Ն80 years of age. Results-As of January 10, 2009, 5297 patients underwent carotid artery stenting in 186 US CAPTURE 2 clinical centers and 1166 were Ն80 years old. Octogenarians were similar to nonoctogenarians in terms of gender and symptomatic status but had fewer of certain risk factors (prior myocardial infarction or carotid endarterectomy, diabetes, smoking history) and more cardiac arrhythmia and renal insufficiency. For the overall cohort, death/stroke rate was 3.3%; stroke rate was 2.7% (0.8% major, 1.9% minor). Death/stroke rates were significantly higher for octogenarians than nonoctogenarians (4.5% versus 3.0%) as were stroke rates (3.8% versus 2.4%). Symptomatic status, embolic protection device dwell time, and lesion length were risk predictors for periprocedural stroke in octogenarians. Conclusions-Patients Ն80 years old have higher periprocedural event rates than nonoctogenarians. Age, symptomatic status, and lesion length should be considered when identifying appropriate candidates for the procedure. (Stroke. 2010; 41:757-764.)

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Carotid artery stenting in octogenarians is associated with increased adverse outcomes

Cited by 92 publications

References 41 publications

Effects of Age and Symptom Status on Silent Ischemic Lesions after Carotid Stenting with and without the Use of Distal Filter Devices

Effects of Age and Symptom Status on Silent Ischemic Lesions after Carotid Stenting with and without the Use of Distal Filter Devices

Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Carotid Artery Stenting in Octogenarians

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