Neuroprotection reduces the risk of peri-procedural major strokes and death in octogenarians

Carotid artery stenting in elderly patients: Importance of case selection

“…In this group's experience, complication rates have diminished considerably from 19.2% in 1998 [16], to 16% in 2001 [10], to 8.5% in 2002 after the advent of routine EPD use [11], and to 3.3% in this current study. Clearly, although EPD use reduced event rates considerably, the further reduction in events seen in this study is most likely due to improved patient selection.…”

“…The technique has matured, and new technologies including EPDs have become available. A further study by this group in patients aged ≥80 years stented with EPDs demonstrated that the stroke or death rate had fallen to 8.5% [11]. Experience with CS has continued to grow, and anatomic and clinical markers for stroke complications have been identified (Table I) [12].…”

“…Using our previous results as a “historical control” [11], we hypothesized that if elderly patients with these adverse factors were carefully screened and excluded, the incidence of stroke and death complications of CS could be further reduced. CS could then be applied to elderly patients with low stroke and death rates, consistent with the American Heart Association (AHA) guidelines for stroke prevention through carotid revascularization [13, 14].…”

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

“…However, Chastain and colleagues 19 reported 30-day stroke, myocardial infarction, and a death rate of 25% among 24 octogenarians compared with 8.2% for 158 patients aged less than 80 years. Subsequently, this group documented a rate of 16% among 63 octoganerians 20 ; however, this was later reduced to 8.5% among 47 patients 32 with the use of neuroprotection. No major strokes or fatal strokes were observed in the group that received cerebral protection.…”

Carotid artery stenting in octogenarians is associated with increased adverse outcomes

“…For instance, many of the patients were stented without cerebral protection, a technical development during the latter half of the study period presumed to decrease stroke rates. 31 Some, in fact, suggest that octogenarians may derive greater benefit in terms of freedom from stroke with use of cerebral protection, 19,32 potentially accounting for the higher stroke rates seen in early studies of octogenarians.…”