Carotid endarterectomy in the octogenarian: Is it appropriate?

Rosenthal, David; Rudderman, Randal; Jones, Dennis H.; Clark, Michael; Stanton, Paul E.; Lamis, Pano A.; Daniels, Wayne W.

doi:10.1016/0741-5214(86)90043-1

Cited by 55 publications

(13 citation statements)

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“…Several prospective randomized trials [2,3,7] have now established the efficacy of this operation in the prevention of stroke; however, these studies did not include patients who are 80 years or older. This series and other reports [8,12,13] (see Table 2) clearly show that this procedure can be carried out in the very elderly population with acceptable operative risks. Short-term follow-up for this group is very encouraging; a majority of the patients in this study continues to enjoy a normal life.…”

Section: Discussionsupporting

confidence: 71%

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

Saha¹,

Rogers²,

Earle³

et al. 2002

Int J Angiol

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Section: Discussionsupporting

confidence: 71%

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

Saha¹,

Rogers²,

Earle³

et al. 2002

Int J Angiol

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“…This compares very favorably with several reports from individual institutions where CEA is performed on a regular basis and that have documented incidences of perioperative stroke ranging from 0% to 5.9% and low mortality among elderly patients. [12][13][14][15][16][17][18][19][20] O'Hara et al 21 report operative mortality and stroke rates of 1.6% and 1.8%, respectively, which is comparable to their results in a younger cohort. In a review of CEAs performed on patients aged 75 years and older, Perler and Williams 16 and Perler et al 22 noted that the incidence of perioperative neurological morbidity among elderly patients (4.8% in patients aged Ն75 years; 5.9% in patients aged Ն80 years) was not different from what they observed among all patients undergoing CEA, irrespective of age; they suggest that the indications for operation and the technical details of the procedure are far more relevant determinants of outcome than the patient's chronological age.…”

Section: Resultsmentioning

confidence: 96%

Carotid Endarterectomy in Elderly Patients

Salameh

Mukherjee²

2002

Arch Surg

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“…The two landmark CEA trials, the North American Symptomatic Carotid Endarterectomy Trail (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS) trials, have clearly established CEA as the gold standard for stroke prevention in patients with both symptomatic and asymptomatic carotid artery stenosis [11]. Data from published reports demonstrates a stroke rate of 16% following conservative management compared to 2% following CEA in age-matched controls after 8 years of follow-up [12]. Moreover, nearly all contemporary CEA outcome studies have documented further improvement in the peri-operative morbidity and mortality over the last two decades, due in large part to the use of carotid duplex instead of angiography, improved medical therapy, the use of patch angioplasty, improved vascular surgical training, and improved anesthesia protocols [13].…”

Section: Discussionmentioning

confidence: 99%

A United States Population-Based Study on Clinical Outcomes Following Primary Carotid Endarterectomy: Who and When?

Patel¹,

Patil²,

Chamberlain³

2012

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Introduction: Carotid Endarterectomy (CEA) is widely recognized as effective in significantly reducing the risk of recurrent stroke emanating from extracranial carotid atherosclerosis and approximately 140,000 carotid endarterectomies are performed annually in the United States (US). As such, data are scarce on the prevalence and clinical outcomes of CEA across different age groups. This study aimed to determine and analyze the prevalence, demographic and clinical outcomes of CEA across six decades of life. Methods: Data on 40,276,240 patients were abstracted from discharge data obtained from the Nationwide Inpatient Sample (NIS) database, a part of the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (2004-2008). Demographic and clinical characteristics of patients undergoing CEA as the primary procedure were abstracted including age, gender, elective or non-elective admission, comorbidities, Length of Stay (LOS), secondary procedures, NIS severity of illness and risk of mortality class, complications and mortality. CEA outcomes were compared across six decades of life starting at age 41. Categorical variables were compared using the Chi-square test, and the Student’s t-test was used to compare continuous variables. Results: 118,947 patients who underwent CEA as their primary procedure were identified. Caucasians accounted for 67.1% of the population. The overall mean age was 71.2 ± 9.5 years, with a Male: Female ratio of 1.3:1. Nineteen percent of patients had non-elective admission, with the highest percentage (29.5%) in those >91 years old. Over three percent of patients had a prior stroke. The overall number of CEA performed peaked in the 8th decade of life (38.4%). The most common co-morbidities were hypertension, diabetes mellitus, and chronic pulmonary disease. Mean LOS was 3.3 days. Forty-two percent of all cases were performed in a teaching hospital, with the percentage increasing with advancing age. The overall mortality and stroke rates were 0.4% and 0.9%, respectively, and these rates were highest in the oldest patients (>91 years). The overall myocardial infarction rate was 0.8% which was highest incidence in the 7th and 9th decades (1.1%). On multivariate analysis, age >80 years (Odds Ratio (OR), 2.9; 95% Confidence Interval (CI), 1.1 - 8.0), Non-white race (OR, 1.7; CI, 1.1 - 2.7), Charlson co-morbidity index score of 1 - 5 (OR, 1.7; CI, 1.3 - 2.4), carotid artery stenosis with stroke at presentation (OR, 1.7; CI, 1.1 - 2.5), Congestive Heart Failure (CHF) (OR, 3.7; CI, 2.8 - 4.8) and renal failure (OR, 2.2; CI, 1.6 - 3.1) were independent risk factors associated with increased CEA mortality. Conclusions: The percent of patients over 80 years is the fastest-growing segment of the US population, and CEA is an increasingly commonly procedure in elderly patients with a low mortality rate across all age groups. On a population level age >80, non-Caucasian race, the presence of specific co-morbidities (i.e., Stoke at presentation, congestive h...

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Carotid endarterectomy in the octogenarian: Is it appropriate?

Cited by 55 publications

References 1 publication

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

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

Carotid Endarterectomy in Elderly Patients

A United States Population-Based Study on Clinical Outcomes Following Primary Carotid Endarterectomy: Who and When?

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