Carotid Endarterectomy in Octogenarians

Abstract

The aim of the present study was to evaluate the outcome of carotid endarterectomy (CEA) for symptomatic carotid artery stenosis (SCAS) in patients >80 years old. This is a retrospective analysis of patients treated with CEA from 2005 to 2022 for SCAS. Patients were divided according to their age in nonoctogenarian (<80 years old) and octogenarian (≥80 years old) and compared for postoperative stroke/death, considering also type of symptoms and the timing of intervention. Clinical visit was performed yearly during the follow-up. In the period examined 457 symptomatic patients were treated by CEA, 166 (36%) were octogenarian (mean age 84 ± 4 years) and had similar preoperative characteristics of nonoctogenarian except for the distribution of preoperative neurological type of symptoms: transient ischemic attack 51% vs 42% (P = .05), amaurosis fugax (14% vs 5%; P = .001), and stroke (36% vs 53%; P = .01). The timing between symptoms and surgery was similar between the two groups 10 ± 8 days vs 8 ± 7 days, respectively (P = .22). Overall, the postoperative rate of stroke/death was similar between octogenarian and nonoctogenarian: 2.4% vs 3.1% (P = .54). Similarly, by stratifying the patients by type of preoperative symptom they did not affect the outcome between older and younger patients: transient ischemic attack (2.4% vs 3.3% P = .63); amaurosis fugax (0% vs 0%; P = 1.0), and stroke (3.4% vs 3.3%; P = 1.0). The timing of CEA did not affect the rate of stroke/death: in octogenarian 3.7%, if performed within 48 hours, 1.6% between 2 and 14 days and 1.3% after 2 weeks (P = .72). At the 5-year follow-up (mean follow-up, 68 ± 14 months), the ipsilateral stroke free survival was 97.6% ± 4% with no differences between octogenarians and nonoctogenarians: 95.2% ± 6% vs 98.1% ± 3% (P = .32). SCAS octogenarian submitted to CEA have low rate of perioperative and follow-up events, comparable with not octogenarian. The timing and the type of symptoms do not seem to affect the CEA outcome.