Why do some patients with > 80% stenosis of the internal carotid artery not undergo surgery? A retrospective review

Abstract

In the present study risk factors associated with increased perioperative morbidity and mortality were the commonest explanation for patients with high-grade stenosis of the internal carotid artery not undergoing surgery. These patients would generally not meet the inclusion criteria for the major carotid endarterectomy trials.

Carotid endarterectomy in octogenarians: Does increased age indicate “high risk?”

“…44 Despite the current results and the contemporary literature, there is a general perception of "high risk" associated with CEA in elderly patients. This perception often leads to recommendations for nonoperative treatment 45 and more recently, suggestions that CAS is preferable to CEA. As pointed out by Rosenthal and colleagues 7 initially and suggested by randomized trial results subsequently, best nonoperative care is not as effective as CEA.…”

Regional Anesthesia in Elderly Patients Undergoing Carotid Surgery: Report of a Case Series

“…Therefore, elderly patients are acknowledged to have a greater risk of mortality and morbidity when undergoing carotid endarterectomy. These circumstances influence recommendations for nonoperative treatment 20 and, more recently, suggestions that carotid artery stenting may be preferable to surgery. There are, however, studies reporting that nonoperative treatment modalities are not as effective as carotid endarterectomy.…”

Combined carotid endarterectomy and oesophagectomy

“…The benefits of combined operations of carotid surgery and coronary artery bypass graft (CABG) are well recognised in decreasing the incidence of stroke [1]; however, combined carotid surgery and major non‐vascular surgery have not been described. We have recently been involved in managing a patient who had a combined endarterectomy and oesophagectomy, and we would like to highlight several issues.…”