IYSC04. American Society of Anesthesiologists Classification and Age Are Highly Significant Predictors of Ipsilateral Stroke-Free Survival in Asymptomatic Octogenarians With Elective Internal Carotid Endarterectomy

Abstract

Internal carotid endarterectomy in asymptomatic octogenarians is a subject of high controversy. The goal of this ongoing retrospective investigation is to determine how far this age limit might be pushed and which indicators might be of relevance. Furthermore, the goal was to determine whether the 2017 guidelines of the European Society for Vascular Surgery (ESVS) were met in hindsight. Asymptomatic patients with internal carotid endarterectomy between January 2011 and January 2014 were followed to determine their 5-year survival and stroke rates. Data were compared with all strong recommendations from the 2017 ESVS guidelines. Perioperative was defined as the 30 days after surgery. Stroke-free survival was determined with SPSS (SPSS Inc., Chicago, Ill) using the Kaplan-Maier method. The influence of a multitude of factors on stroke-free survival was calculated with Cox regression. Between January 1, 2011, and January 1, 2014, 78 asymptomatic octogenarians underwent internal carotid endarterectomy at our university hospital. There were 38 males and 40 females, with a mean age of 82.7 years; 71.8% were under sufficient blood pressure-lowering therapy, 15.4% had insufficient treatment, 3.8% had untreated ,hypertension and 9% showed normal blood pressure. Diabetes was present in 24.4%, previous cardiac infarction in 25.6%, previous coronary artery bypass grafting in 11.5%, nonrecent ipsilateral stroke in 7.7%, and nonrecent contralateral stroke in 17.9%. There was one perioperative death (5 days after discharge, the patient died of heart failure in another hospital). Mean stroke-free survival was 5.4 years (95% confidence interval [CI], 4.8-6.0 years). During follow-up, one patient experienced a minor ipsilateral stroke (Rankin 2). There were two factors with a significant impact on stroke-free survival: American Society of Anesthesiologists (ASA) classification (P = .01; ASA class I-III, 6.0 years; ASA class IV, 4.6 years) and age (P = .01; 80-82 years of age, 5.4 years; 83-89 years of age, 5.0 years). There was one perioperative death 5 days after discharge. Mean stroke-free survival was 5.4 years. During follow-up, one patient experienced minor ipsilateral stroke. The factors with significance for stroke-free survival were ASA classification and age. Thirty-seven of the current ESVS recommendations were applicable to the study population, of which 28 were met. Carotid endarterectomy in asymptomatic octogenarians is possible with a low perioperative stroke and death rate. Out of a multitude of parameters ASA classification and age could be determined as significant factors in our patient population. Although our Results are good, following the ESVS's recommendations more closely might further improve results. Collecting more data and determining specific risk factors in this particular subgroup of patients will enable us to improve the selection process for internal carotid endarterectomy in asymptomatic octogenarians.