Preoperative risk factors for carotid endarterectomy: defining the patient at high risk

Abstract

CEA can be safely performed in patients deemed at high risk, including those aged 80 years or older and others with significant comorbid conditions, with combined stroke and mortality rates comparable to those found in randomized trials, ie, the Asymptomatic Carotid Atherosclerosis Study and the North American Symptomatic Carotid Endarterectomy Trial. Contralateral occlusion may be a predictor for moderately increased perioperative risk and for reduced long-term survival. Caution may be warranted in asymptomatic patients with multiple risk factors, in whom presumed long-term benefit of CEA may be compromised by markedly reduced 5-year survival.

Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

“…22 Other authors published studies about the definition and conduct in high-risk patients. [60][61][62] Gasparis et al 60 defined high risk in two groups: physiological risk and anatomic risk. In the former, they included 80 patients older than 80 years, 11 with AMI over the past 6 months, 16 with heart failure, chronic pulmonary occlusive disease and 13 with serum creatinine levels above 3 mg/dL.…”

Carotid Endarterectomy for Patients over 80 Years Old

“…Because age greater than 80 years is considered as one of the risk factors identified by the SAPPHIRE trial (Table 1), the view of old age as a risk factor appears to have been widely adopted. However, many of the studies that indicated age as a risk factor did not detect a strong, but only a "slight", correlation with risk [6][7][8]. Although age can be a risk factor for CEA at present, it does not appear to be a factor precluding the use of CEA for carotid artery stenosis in the elderly.…”

“…However, the conclusions of these studies and reviews vary. Several studies reported that age is a risk factor for surgery, while others indicated the contrary [6][7][8][9]. Because age greater than 80 years is considered as one of the risk factors identified by the SAPPHIRE trial (Table 1), the view of old age as a risk factor appears to have been widely adopted.…”

“…Reed et al reported that, although age alone is not a perioperative risk factor for CEA, the perioperative risk increases in patients with several risk factors, including age [8]. In particular, the occurrence or exacerbation of coronary disease during the perioperative period is an important issue and can sometimes be critical [13].…”

“…However, the superiority of either CEA or CAS in terms of safety and efficacy for high-risk patients remains debatable. In particular, there are many reports on the use of CEA in the elderly population [6][7][8][9]. Indeed, CEA is still used for elderly patients, with some reports indicating CEA as a better treatment option for this patient group [10][11][12].…”