Carotid Endarterectomy Outcomes in the Elderly: A Canadian Institutional Experience

Doonan, R.J.; Abdullah, Abdullah; Steinmetz-Wood, Samantha; Mekhaiel, Sandra; Steinmetz, Oren K.; Obrand, Daniel I.; Corriveau, Marc M.; MacKenzie, Kent S.; Gill, Heather L.

doi:10.1016/j.avsg.2018.12.084

Cited by 11 publications

(5 citation statements)

References 16 publications

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“…[23][24][25][26] Moreover, several other studies have underlined no difference regarding the perioperative stroke and death rate between the octogenarians with ACS and the younger patients. [27][28][29][30] Our study confirmed that there is no statistically significant difference between the octogenarians and the younger patients regarding the following 30-day parameters: the mortality rate (p = 1.0), the ipsilateral stroke rate (p = .7) and the ipsilateral stroke/death rate (p = .7).…”

Section: Discussionsupporting

confidence: 71%

Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years

et al. 2021

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Background The following study investigated the 30-day and 5-year relative survival rate and freedom from neurological events in asymptomatic carotid stenosis (ACS) octogenarians who had undergone elective carotid endarterectomy (CEA). Methods Between January 2008 and June 2014, a retrospective review was conducted on ACS patients who had undergone elective CEA. The patients’ sample was divided into two groups: Group A (GA) included octogenarians and Group B (GB) included younger patients. The GA patients were subjected to a risk-scoring system and follow-up. The two groups were compared analysing the following primary endpoints: 30-day mortality, stroke, stroke/death and acute myocardial infarction (AMI); GA patients’ survival rate and freedom from neurological events at 5 years. The 30-day secondary endpoints included carotid shunting, redo surgical, need for general anaesthesia with preserved consciousness (GAPC) conversion and length of hospital stay. Results We identified 620 patients with ACS, of them 144 (23.2%) belonged to the GA and 476 (76.8%) belonged to the GB. No statistical difference between the two groups was found regarding the primary and secondary endpoints. One hundred nineteen of 144 GA patients (82.6%) underwent the follow-up; the median follow-up was 78.3 months. The GA patients’ 5-year survival rate was 62%, while freedom from cerebral events was 94.9%. Analysis regarding GA patients’ 5-year survival rate revealed a significantly lower percentage among the patients with a severe risk score compared with those with a moderate risk score (respectively, 29.5% vs 67.7%; p = .005). The multivariate analysis showed that chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) were independently associated with lower survival. Conclusions The 30-day outcomes of CEA in octogenarians are comparable to those in younger patients. Comprehensive life expectancy and preoperative score, rather than age alone, should be taken into account before performing CEA on octogenarian patients, considering the short- and long-term efficacy in stroke prevention.

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Section: Discussionsupporting

confidence: 71%

Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years

et al. 2021

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“…A meta-analysis published by Ballota, collecting 845 CEA performed in patients over 75 years old but symptomatic, found an average cumulative post-operative mortality and neurological morbidity rate of 3.3% [ 7 ]. Another confirmation comes from a Canadian study which shows that carotid surgery in elderly patients, even asymptomatic, is not accompanied by an increase in mortality and neurological morbidity but that the post-operative complications, particularly myocardial infarction, should consider a reflection on the advisability of performing CEA in an elderly patient [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

The management of asymptomatic carotid stenosis: Is there a benefit to operate elderly patients?

Bouayed¹

2021

Translational Medicine @ UniSa

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Background We present a retrospective study of a series of 40 patients over the age of 75 operated for an asymptomatic carotid stenosis. The results were evaluated during an average of 3 years of follow-up. Material and method The study is retrospective and monocentric. The series includes 40 patients aged over 75 years and with an average age of 78.5 years (range 75–82). Patients underwent surgery for an asymptomatic carotid stenosis of more than 80%. The technique in all case was a carotid endarterectomy. Results There have been no postoperative deaths or neurological adverse events. During an average follow-up of 3 years, there was one death secondary to colon cancer. However, 5 patients were lost to follow-up. Conclusion Carotid surgery in elderly patients may have a benefit. However, our study has shortcomings. It is retrospective and the patient cohort is reduced. A randomized, prospective study, comparing surgery or angioplasty with the best medical treatment, is necessary to choose the most effective and safest treatment to offer to an elderly patient with asymptomatic carotid stenosis.

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“…Stroke is a known leading cause of mortality and disability globally (1). Extracranial stroke is usually embolization from the carotid plaque and hemodynamic compromise as a result of carotid artery stenosis (2,3). Internal carotid artery (ICA) atherosclerosis is a cause of up to 15% of ischemic strokes (4).…”

Section: Introductionmentioning

confidence: 99%

Reliability of tomographic 3D ultrasound in measuring internal carotid artery plaque volume

Alzahrani,

Sultan,

Aslam

2023

Acta Radiol

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Background Tomographic 3D ultrasound (t3DUS) is a promise imaging technique for quantifying carotid plaque through measuring the degree of stenosis and plaque volume. Carotid plaque volume (CPV) could add benefit in predicting the potential risk of stroke. Purpose To assess the reproducibility and accuracy of t3DUS for measuring CPV within the internal carotid artery in patients undergoing carotid endarterectomy. Material and Methods t3DUS was used to obtain CPV in vivo from 25 symptomatic patients prior to surgery. Ex vivo CPV from the carotid endarterectomy specimen was then measured using a validated saline displacement method as a reference standard. CPV for each patient was measured twice using both methods (total n = 50 per technique). Intraclass correlation coefficient (ICC) and Bland–Altman plot were used to establish bias and limit of agreement between CPV measurements. Results There was an excellent agreement between t3DUS and reference test with respect to measuring CPV with an ICC value of 0.98 (95% confidence interval = 0.97–0.99, P < 0.001). Bias in measurements was 0.02 ± 0.11 cm3 (95% limit of agreement = −0.19 to 0.25). Intra-observer agreement of t3DUS CPV measurements was excellent with an ICC value of 0.95 (95% confidence interval = 0.92–0.97, P < 0.001). Bias in measurements was 0.004 ± 0.07 cm3 (95% limit of agreement = −0.14 to 0.15). Conclusion t3DUS is a reproducible imaging method and showed excellent agreement with the reference standard with respect to measuring CPV. These findings suggest that t3DUS has the potential to be a valuable non-invasive tool for assessing carotid plaque burden and predicting the risk of stroke.

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Carotid Endarterectomy Outcomes in the Elderly: A Canadian Institutional Experience

Cited by 11 publications

References 16 publications

Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years

Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years

The management of asymptomatic carotid stenosis: Is there a benefit to operate elderly patients?

Reliability of tomographic 3D ultrasound in measuring internal carotid artery plaque volume

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