Influence of Age Upon Complications of Carotid Artery Stenting

Hd, Chastain; Cr, Gomez; Iyer, S.S.; Gs, Roubin; Jj, Vitek; Jb, Terry; Rl, Levine

doi:10.1583/1074-6218(1999)006<0217:ioauco>2.0.co;2

Cited by 66 publications

(15 citation statements)

References 18 publications

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“…However, this beneficial effect could not be observed in asymptomatic or older patients. Because advanced age has been associated with a significantly increased stroke risk during unprotected CAS, 19,20 the finding that older patients might not profit from the use of cerebral protection devices is of great practical importance. Although it could principally be argued that DWI lesions do not necessarily represent irreversible brain damage, 21 we could demonstrate recently a close correlation between the number of new DWI lesions and clinical outcome after CAS.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…Moreover, the aging population has presented new treatment challenges. [18][19][20][21][22][23][24] In particular, recent data suggest that octogenarians are at particularly high risk for CAS, 20,23,24 though various single-center experiences have reported the safety of CAS in this subgroup. 19,21,21,25,26 In this report of the 4-year outcomes of the CaRESS trial, we examine the CMS coverage guidelines for CAS in a series of subgroup analyses that stratify this large, broad-risk patient cohort by risk status, symptomatology, stenosis grade, and age .80 years.…”

Section: ¤ ¤mentioning

confidence: 99%

Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS):4-Year Outcomes

Zarins

White

Diethrich

et al. 2009

Journal of Endovascular Therapy

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¤ ¤Purpose: To examine the 4-year outcomes from Carotid Revascularization using Endarterectomy or Stenting Systems (CaRESS) in light of the current reimbursement guidelines for carotid artery stenting (CAS) from the Centers for Medicare and Medicaid Services (CMS).Methods: CaRESS was designed as a prospective, nonrandomized comparative cohort study of a broad-risk population of symptomatic and asymptomatic patients with carotid stenosis. In all, 397 patients (247 men; mean age 71 years, range 43-89) were enrolled and underwent carotid endarterectomy (CEA; n5254) or protected CAS (n5143). More than 90% of patients had .75% stenosis; two thirds were asymptomatic. The primary endpoints included (1) all-cause mortality, (2) any stroke, and (3) myocardial infarction (MI), as well as the composite endpoints of (4) death and any nonfatal stroke and (5) death, nonfatal stroke, and MI. The secondary endpoints were restenosis, repeat angiography, and carotid revascularization. All patients were classified with respect to surgical risk, symptom status, and stenosis grade based on criteria published by the CMS. In addition, separate analyses were performed comparing genders and octogenarians to those ,80 years old.Results: No significant differences in the primary outcome measures were found between the CEA and CAS groups in the 4-year analysis. The incidences of any stroke at 4 years were 9.6% for CEA and 8.6% for CAS (p50.444); when combined with death, the composite death/nonfatal stroke rates were 26.5% for CEA versus 21.8% for CAS (p50.361). The composite endpoint of death, nonfatal stroke, and MI at 4 years was 27.0% in CEA versus 21.7% in CAS (p50.273) patients. The secondary endpoints of restenosis (p50.014) and repeat angiography (p50.052) were higher in the CAS arm. There were no differences in any of the subgroups stratified according the CMS guidelines or in the gender comparison. Four-year incidences of death/nonfatal stroke and death/nonfatal stroke/MI were higher in the CEA arm among patients ,80 years of age (p50.049 and p50.030, respectively). There were no significant differences between these incidences in the octogenarian subgroup.

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“…В исследовании CREST продемонстрировано, что возраст является предиктором увеличения частоты ОНМК после операции [4,10]. Основными причинами ОНМК в данном случае считают эмболические осложне-ния.…”

Section: Discussionunclassified

Cerebral revascularization in patients older than 70 years

Николаевич¹,

Александрович²,

Андреевич³

2015

Kardiol. serdechno-sosud. khir.

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За последние 40 лет население земного шара прогрес-сивно стареет [9]. Эффективность и безопасность хирургиче-ского лечения атеросклеротических заболеваний брахице-фальных артерий (БЦА) у больных старшей возрастной груп-пы становятся наиболее актуальными в настоящее время. Материал и методыВ исследование включены 813 больных в возрасте старше 70 лет, которым выполнена реваскуляризация го-ловного мозга (ГМ). В 1-ю группу включены 392 пациента Материал и методы. В исследование включены 813 больных в возрасте старше 70 лет, которым выполняли реваскуляризацию головного мозга (ГМ). В 1-ю группу включены 392 пациента, которым выполнена каротидная эндартерэктомия (КЭАЭ), во 2-ю -421, которым выполнено стентирование сонных артерий (ССА). Больные в обеих группах были схожи по исходной тяжести основной патологии и сопутствующим заболеваниям.Результаты. У больных старше 70 лет частота острого нарушения мозгового кровообращения (ОНМК) после КЭАЭ была значительно меньше, чем при ССА (р=0,04). Частота периоперационных инфарктов миокарда (ИМ) выше в 3 раза при КЭАЭ (р=0,03).Выводы. Наименьшее число ОНМК у больных старше 70 лет наблюдается при КЭАЭ, однако этот метод несет в себе угрозу развития периоперационного ИМ. ССА возможно проводить у больных с тяжелой кардиальной патологией при неэмболоопасных атеросклеротических бляшках.Ключевые слова: стентирование сонных артерий, каротидная эндартерэктомия, реваскуляризация головного мозга, острое нарушение мозгового кровообращения, старше 70 лет.

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Influence of Age Upon Complications of Carotid Artery Stenting

Cited by 66 publications

References 18 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

Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS):4-Year Outcomes

Cerebral revascularization in patients older than 70 years

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