One-Year Clinical Outcomes, Midterm Survival, and Predictors of Mortality After Carotid Stenting in Elderly Patients

Abstract

Background-It has been demonstrated recently that carotid stenting can be performed safely in patients Ն80 years of age.However, it is uncertain whether these patients will derive benefit because longevity after revascularization is an important consideration. This study was conducted to determine survival and predictors of mortality of selected elderly patients after stenting. Methods and Results-One hundred forty-two consecutive elderly patients who were non-high risk for stenting underwent 153 procedures. Patients had either symptomatic stenosis Ն50% or asymptomatic stenosis Ն70%. Demographics and in-hospital outcomes were entered into a database; subsequent outcomes and mortality data were obtained retrospectively. MeanϮSD age was 83.3Ϯ3.1 years. Symptomatic patients accounted for 28%. Overall survival at 3 years was 76% (85% at 2 years). At 1 year, 1 fatal stroke had occurred, with 97% of survivors (nϭ114) free of neurological events (neurological status was undetermined in the remaining 3%). Predictors of mortality were remote (Ն6 months) transient ischemic attack or cerebrovascular accident, smoking history, and creatinine clearance (hemoglobin level showed a strong trend toward achieving significance); for the asymptomatic subgroup, predictors of mortality were smoking history, previous carotid endarterectomy, hemoglobin level, and increasing age. In particular, symptom status and sex were not independent predictors of mortality. Conclusions-This study demonstrates that in selected elderly patients, a high proportion (85%) survived 2 years and Ͼ75% survived 3 years after stenting. Carotid stenting may be considered a revascularization option in such patients. Better selection of patients using the predictors of mortality may help to reduce unwarranted procedures and to optimize survival likelihood.

Outcomes After Carotid Artery Stenting and Endarterectomy in the Medicare Population

“…Although it is difficult to compare in-hospital and 1-year results from the present study to other investigations because of differences in methodology and study population, the rates of in-hospital stroke and mortality in the present study are similar to those reported in CAS registries and randomized, controlled, clinical trials. 10,[25][26][27][28][29] It may be that mortality is truly increased with CAS relative to CEA. There are reasons, however, to believe that there are more cogent explanations for the mortality difference.…”

Carotid Stenting in the Elderly

“…8 This series of patients has previously been reported, with the current article adding observations related to intermediate-term survival. 9 Of these 142 patients, 72% were asymptomatic.…”

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

“…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.…”

“…Research demonstrates that 85% of the selected elderly patients survived 2 years and ≥75% survived 3 years after stenting. Therefore, for this group, carotid stenting may be considered as a revascularization option (Chiam et al., 2009). But it is still necessary to evaluate the longer‐term outcomes to better understand the role of CAS in this population and to allow them to gain more benefit from this procedure.…”

“…Recently, CAS for ICA steno‐occlusion has made great progress in improving the rates of severe disability and death in patients over 80. In effect, reports have demonstrated that CAS can be performed in octogenarians with stroke and death rates comparable to younger patients (Bacharach, Slovut, Ricotta, & Sullivan, 2010; Chiam et al., 2009; Grant et al., 2010; Naylor, 2016; Ouyang, Jiang, Yu, Zhang, & Huang, 2015). A large series of CAS showed a 2.8% stroke and death rate in 30 days and a cumulative 3.3% of major cardiovascular events (stroke, death, or myocardial infarction), which suggested that CAS could be performed safely in patients over 80 (Grant et al., 2010).…”