Carotid endarterectomy in octagenarians and nonagenarians in a community hospital: An outcome analysis

Abstract

Carotid endarterectomy in very elderly patients remains controversial. We report our experience with this operation on 101 very elderly patients at the Baptist Heart Institute, a community hospital in Lexington, Kentucky. Ages ranged from 80 to 93 years with an average age of 86.5 years. There are 7 nonagenarians in this study. The indications included asymptomatic severe carotid artery stenosis in 29 (29.7%) patients and symptomatic disease in 72 patients (71.3%). Sixty eight percent of the patients had significant co-morbidity that included hypertension, diabetes mellitus, lipid disorders, previous stroke, previous carotid endarterectomy, coronary artery disease and previous myocardial infarctions. Thirty two percent of the patients had no significant past medical history. Two deaths occurred during hospitalizations (1.98%). One of these patients had carotid endarterectomy in conjunction with coronary artery bypass grafting. This patient suffered a stroke. The second death occurred as the result of respiratory failure. There was 1 perioperative infarct. From this study, we conclude that carotid endarterectomy can be performed safely in very elderly patients in a community hospital.