Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase

Hobson, Robert W.; Howard, Virginia J.; Roubin, Gary S.; Brott, Thomas G.; Ferguson, R.; Popma, Jeffrey J.; Graham, Darlene L.; Howard, George

doi:10.1016/j.jvs.2004.10.022

Cited by 503 publications

(351 citation statements)

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“…In our study, age was not an important factor in determining the incidence of permanent neurologic deficits during the periprocedural period. Similarly, in other monocentric studies, there is no evidence of a causal link between perioperative neurologic complications and advanced age (Bacharach et al., 2010; Chrysant, Prabhu, Tebow, & Snowden, 2009), although several RCTs showed an increased incidence of complications in octogenarians (Chaturvedi, Matsumura, Gray, Xu, & Verta, 2010; Hobson et al., 2004). …”

Section: Discussionmentioning

confidence: 99%

“…However, there are conflicting results about adverse events associated with carotid stenosis in very elderly patients (Chiam et al., 2009; Hobson et al., 2004; Howard et al., 2016). Early studies showed that adverse events rates in octogenarians undergoing CAS were 25% as compared to 8.2% in younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…(2001). The lead‐in phase of the CREST trial showed that the periprocedural risk of stroke and death after CAS increased with age and was 12.1% in patients aged over 80, significantly above the rates for patients aged 70–79 (5.3%), 60–69 (1.3%), and less than 60 (1.7%) (Hobson et al., 2004). …”

Section: Discussionmentioning

confidence: 99%

“…However, CAS in octogenarians is a still a debated subject, given the unsatisfactory results observed in multicenter randomized controlled trials (RCTs) (e.g., EVA 3S,SPACE, ICSS) and the fact that some researchers see increasing age as a predictor of poor outcomes. In very elderly patients (≥80 years old), CAS may be linked to increased periprocedural morbidity and mortality (Hobson et al., 2004; Stanziale et al., 2006). Thus, patients aged over 80 years old were excluded from some clinical trials evaluating CAS (Barnett et al., 1991).…”

Section: Introductionmentioning

confidence: 99%

“…The CREST trial reported a 12.1% stroke or death rate at 30 days following CAS in octogenarians. This was not influenced by symptomatic status, lesion severity, and use of distal embolic protection devices (Hobson et al., 2004). Recently, CAS for ICA steno‐occlusion has made great progress in improving the rates of severe disability and death in patients over 80.…”

Section: Introductionmentioning

confidence: 99%

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Immediate and late outcomes of stenting for severe extracranial internal carotid artery stenosis in octogenarian patients

Duan

Dai

et al. 2017

Brain and Behavior

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BackgroundMultiple studies suggest that internal carotid artery stenting can be performed safely in octogenarians with low periprocedural complication rates. However, great concern still exists as to whether these patients will gain long‐term benefits from this procedure given their advanced age and uncertain life expectancy. We decided to conduct a retrospective study to determine short‐and long‐term clinical outcomes and to analyze survival duration in this population.Methods and ResultsSixty‐nine consecutive elderly patients with either symptomatic or asymptomatic stenosis ≥70% underwent 86 procedures. Immediate and late outcomes, as well as survival data, were analyzed retrospectively. Mean age was 83.1 ± 2.7 years. Mean survival was 49.3 ± 10.1 months. A complete neurological assessment was obtained at 1 and 2 years in 100% of patients, at 3 years in 90.7% of patients and at 5 years in 84.8% of patients. Two major and one minor ischemic strokes occurred during the periprocedural period. No death, myocardial infarction or intracranial hemorrhage was recorded. The mean follow‐up period was 55.4 ± 24.6 months. Four patients experienced a minimum of 1 year of follow‐up, and the longest is 8 years. Among the patients with the longest follow‐up time, 6 had ischemic strokes, of which 2 were fatal. In total, 17 deaths occurred. Four patients experienced dementia without stroke. Survival at 3 and 5 years was estimated to be 90% and 73%, respectively.ConclusionThis study demonstrated that stenting in octogenarians was safe and effective during the periprocedural period. Long‐term follow‐up showed a low rate of fatal and nonfatal stroke, and patients survived long enough to benefit from the procedure. However, it was associated with a relatively high rate of long‐term event. Though carotid artery stenting is a minimally invasive procedure, it should still be performed with great caution and only in carefully selected patients. The present study suggested that in this age population, carotid artery stenting might be considered as a revascularization option.

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