Carotid Endarterectomy or Stenting in Octogenarians in a Monocentric Experience

Fantozzi, Cristiano; Taurino, Maurizio; Rizzo, Luigi; Stella, Nazzareno; Persiani, Francesca

doi:10.1016/j.avsg.2015.10.039

Cited by 11 publications

(3 citation statements)

References 43 publications

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“…The study cohorts ranged from 65 to 6940 patients. All articles presented the results of observational, retrospective, comparative studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The studies' characteristics are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Early Outcomes of Carotid Revascularization in Retrospective Case Series

Nana

Kouvelos

Brotis

et al. 2021

JCM

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Background: Most data in carotid stenosis treatment arise from randomized control trials (RCTs) and cohort studies. The aim of this meta-analysis was to compare 30-day outcomes in real-world practice from centers providing both modalities. Methods: A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. Only studies reporting on 30-day outcomes from centers, where both techniques were performed, were eligible for this analysis. Results: In total, 15 articles were included (16,043 patients). Of the patients, 68.1% were asymptomatic. Carotid artery stenting (CAS) did not differ from carotid endarterectomy (CEA) in terms of stroke (odds ratio (OR) 0.98; 0.77–1.25; I2 = 0%), myocardial ischemic events (OR 1.03; 0.72–1.48; I2 = 0%) and all events (OR 1.0; 0.82–1.21; I2 = 0%). Pooled stroke incidence in asymptomatic patients was 1% (95% CI: 0–2%) for CEA and 1% for CAS (95% CI: 0–2%). Pooled stroke rate in symptomatic patients was 3% (95% CI: 1–4%) for CEA and 3% (95% CI: 1–4%) for CAS. The two techniques did not differ in either outcome both in asymptomatic and symptomatic patients. Conclusion: Carotid revascularization, performed in centers providing both CAS and CEA, is safe and effective. Both techniques did not differ in terms of post-procedural neurological and cardiac events, both in asymptomatic and symptomatic patients. These findings reiterate the importance of a tailored therapeutic strategy and that “real-world” outcomes may only be valid from centers providing both treatments.

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Section: Resultsmentioning

confidence: 99%

Early Outcomes of Carotid Revascularization in Retrospective Case Series

Nana

Kouvelos

Brotis

et al. 2021

JCM

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“…There were 2.3% death and stroke at 30 days in the group treated by CAS and 4.4% in the group treated by CEA. The author of this study underlines that if the CAS is carried out by an experienced team, octogenarians can benefit from it with more safety [ 11 ]. The complex arterial anatomy of the elderly may explain the high rate of complications after CAS in patients over 80 years of age [ 12 ].…”

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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“…36 Others were single-institution reports with high stenting experience. [37][38][39][40][41] Additionally, publication bias might have hindered institutions from reporting negative results.…”

Section: Discussionmentioning

confidence: 99%