Carotid endarterectomy in octagenarians and nonagenarians in a community hospital: An outcome analysis

Saha, Sibu P.; Rogers, Anthony G; Earle, Gary F.; Nachbauer, Craig A.; Mitchell, Robert O.; Khalil, Bassam Abu; Khansarinia, Saeid

doi:10.1007/s00547-001-0051-y

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…Nonetheless, most studies suggest that the operative risk for CEA in the elderly is not significantly increased. [60][61][62]…”

Section: Symptomatic Carotid Artery Stenosismentioning

confidence: 99%

Carotid Endarterectomy: Current Concepts and Practice Patterns

Saha

2015

Int J Angiol

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Background Stroke is the number one cause of disability and third leading cause of death among adults in the United States. A major cause of stroke is carotid artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have varying results regarding the equivalence and perioperative complication rates of stents versus carotid endarterectomy (CEA) in the management of CAS. Objectives We review the evidence for the current management of CAS and describe the current concepts and practice patterns of CEA. Methods A literature search was conducted using PubMed to identify relevant studies regarding CEA and stenting for the management of CAS. Results The introduction of CAS has led to a decrease in the percentage of CEA and an increase in the number of CAS procedures performed in the context of all revascularization procedures. However, the efficacy of stents in patients with symptomatic CAS remains unclear because of varying results among randomized trials, but the perioperative complication rates exceed those found after CEA. Conclusions Vascular surgeons are uniquely positioned to treat carotid artery disease through medical therapy, CEA, and stenting. Although data from randomized trials differ, it is important for surgeons to make clinical decisions based on the patient. We believe that CAS can be adopted with low complication rate in a selected subgroup of patients, but CEA should remain the standard of care. This current evidence should be incorporated into practice of the modern vascular surgeon.

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“…Nonetheless, most studies suggest that the operative risk for CEA in the elderly is not significantly increased. [60][61][62]…”

Section: Symptomatic Carotid Artery Stenosismentioning

confidence: 99%

Carotid Endarterectomy: Current Concepts and Practice Patterns

Saha

2015

Int J Angiol

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Metaanalysis of Procedural Stroke and Death among Octogenarians: Carotid Stenting versus Carotid Endarterectomy

Usman

Tang²,

Eskandari

2009

Journal of the American College of Surgeons

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Is Age of 80 Years a Threshold for Carotid Revascularization?

Reichmann¹,

Lammeren²,

Moll³

et al. 2011

CCR

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Background and purpose:Carotid Angioplasty and Stenting (CAS) has emerged as an alternative to Carotid Endarterectomy (CEA) in treatment of carotid stenotic disease. With increasing life expectancy clinicians are more often confronted with patients of higher age. Octogenarians were often excluded from randomized trials comparing CAS to CEA because they were considered high-risk for revascularization. Conflicting results on the peri-procedural outcome of carotid revascularization in these patients have been reported. In order to objectively evaluate whether age above 80 years should be an upper limit for indicating carotid revascularization we systematically reviewed the currently available literature.Methods:Literature was systematically reviewed between January 2000 and June 2010 using Pubmed and Embase, to identify all relevant studies concerning CAS and CEA in octogenarians. Inclusion criteria were 1) reporting outcome on either CEA or CAS; and 2) data subanalysis on treatment outcome by age. The 30-day Major Adverse Event (MAE) rate (disabling stroke, myocardial infarction or death) was extracted as well as demographic features of included patients.Results:After exclusion of 23 articles, 46 studies were included in this review, 18 involving CAS and 28 involving CEA. A total of 2.963 CAS patients and 14.365 CEA patients with an age >80 years were reviewed. The MAE rate was 6.9% (range 1.6 - 24.0%) following CAS and 4.2% (range 0 – 8.8%) following CEA.A separate analysis in this review included the results of one major registry 140.376 patients) analyzing CEA in octogenarians only reporting on 30-day mortality and not on neurological or cardiac adverse events. When these data were included the MAE following CEA is 2.4% (range 0 – 8.8%)Conclusions:MAE rates after CEA in octogenarians are comparable with the results of large randomized trials in younger patients. Higher complication rates are described for CAS in octogenarians. In general, age > 80 years is not an absolute cut off point to exclude patients from carotid surgery. In our opinion, CEA should remain the golden standard in the treatment of significant carotid artery stenoses, even in the very elderly.

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Carotid endarterectomy in octagenarians and nonagenarians in a community hospital: An outcome analysis

Cited by 3 publications

References 12 publications

Carotid Endarterectomy: Current Concepts and Practice Patterns

Carotid Endarterectomy: Current Concepts and Practice Patterns

Metaanalysis of Procedural Stroke and Death among Octogenarians: Carotid Stenting versus Carotid Endarterectomy

Is Age of 80 Years a Threshold for Carotid Revascularization?

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