Age and carotid intervention outcomes

Abstract

In The Lancet, the Carotid Stenting Trialists' Collaboration (CSTC) present a meta-analysis of the effect of increasing age on perioperative death or stroke related and late ipsilateral stroke in 4754 symptomatic patients randomised to carotid endarterectomy (CEA) or carotid artery stenting (CAS) in three European randomised controlled trials (RCTs; EVA-3S, SPACE, and ICSS) and one North American RCT (CREST). 1 Howard G Roubin GS Jansen O et al. on behalf of the Carotid Stenting Trialists' CollaborationAssociation between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet. 2016; (published online Feb 12.)http://dx.doi.org/10.1016/S0140-6736(15)01309-4 Google Scholar Key findings were that once the perioperative period (between randomisation and 120 days) passed, there was no difference in late ipsilateral stroke between CEA and CAS, irrespective of age, and that increasing age had no effect on procedural risks after CEA, but there was a stepwise increase in perioperative stroke or death after CAS, contributing to the CAS versus CEA treatment difference, which became apparent at 65–69 years of age (hazard ratio 1·81, 95% CI 0·97–3·38) and most pronounced over the age of 70 (2·28, 1·39–3·75). Because there was no difference in stroke rates after the perioperative period, the magnitude of the procedural risk will ultimately determine whether CEA or CAS is safer in individual patients. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trialsIn these RCTs, CEA was clearly superior to CAS in patients aged 70–74 years and older. The difference in older patients was almost wholly attributable to increasing periprocedural stroke risk in patients treated with CAS. Age had little effect on CEA periprocedural risk or on postprocedural risk after either procedure. Full-Text PDF