Papers from the Southern California Vascular Surgery Society 1991 Meeting
Carotid Endarterectomy in the Elderly

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The records of 146 patients 80 years of age or older who underwent 183 carotid endarterectomy operations from 1964 through 1990 were reviewed to determine surgical risk. The indications for operation were asymptomatic patients with carotid stenosis (n = 36); ipsilateral transient ischemic attacks (n = 46); ipsilateral stroke (n = 28); ipsilateral retinal embolus (n = 15); nonlateralizing symptoms (n = 40); and asymptomatic side in patients with contralateral symptoms (n = 18). Postoperatively, three patients (1.6% of operations) had a stroke with a residual deficit and three (1.6%) died. All deaths were from myocardial infarction. For comparison, during the same time period, the combined stroke with residual deficit and death rate for patients less than 80 operated upon for similar indications was 3.5%. Since 80-year-old patients have a life expectancy of at least five years, the authors conclude that elderly patients should be evaluated for carotid endarterectomy using criteria similar to that used for younger patients.

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    The five- and seven-year relative survival rates of the elderly patients were 112.5% and 99.8%, respectively (Fig 3). The results of this study show that CEA is safe and effective in patients with severe symptomatic and asymptomatic ICA stenosis, with a combined mortality and stroke rate of less than 1%, and that CEA can be performed in patients ≥ 80 years old with perioperative stroke risk and death rates comparable with those of younger patients, as reported in many other institutional series18-31 (Table V). Moreover, these findings correlate well with, and expand on the results of our two previous, smaller studies on early outcomes in this patient population.32,33

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    A recently published pooled analysis of > 2,500 patients reported a combined stroke mortality of 3.45% after carotid endarterectomy in octogenarians.13 Several articles have determined that there exists no substantial increase in combined stroke and death end points after endarterectomy when patients older than 80 are compared with a younger cohort.12,13,18 Results in our series tend to bear this out.

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    Medicare data from the 1980s reflect a three- to fourfold increase in morbidity and mortality in patients over the age of 75 or 80 years.16,17 However, multiple single-institution series have shown that CEA can be performed in the elderly without an increase in risk.3,5,6,9,18-22 Most studies on the elderly have focused on patients over the age of 80.

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Presented at the Tenth Annual Meeting of the Southern California Vascular Surgical Society, September27–29 1991, Marina Del Rey, California.

Reprint requests: Richard L. Treiman, MD, 8631 West Third Street, Los Angeles, California 90048.

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