Should patient age be a consideration in carotid endarterectomy?

Abstract

Age as a factor in the selection of patients for carotid endarterectomy was studied with a retrospective evaluation of the perioperative and late results of procedures performed on 115 elderly patients. The results were taken from an experience of 685 operations performed on 607 patients. Perioperative results in 420 patients under 75 years of age (560 operations) were compared with results in 115 patients over 75 years of age (125 operations). Statistical comparison revealed a greater proportion of men in group I (66%, 55%, p = 0.0186) and a greater proportion of patients in group II with contralateral carotid stenosis (24%, 33%, p = 0.0382) and stroke as a preoperative indication for operation (14%, 22%, p = 0.0393). No statistical difference was found between group I and group II as regards other operative indications, contralateral carotid occlusion, bilaterality of operation, emergency operation, operation for recurrent carotid disease, frequency of shunt use, perioperative wound bleeding, and perioperative transient ischemic attack. Ipsilateral perioperative stroke occurred in 12 patients (2%), with all strokes occurring in the younger group of patients (2.4%) (NS). Perioperative death occurred in six (1%) patients, with five deaths (1%) occurring in the younger group (cardiac, 2; stroke, 2; protamine reaction, 1) and one (0.9%) death occurring in the elderly group of patients (ruptured abdominal aortic aneurysm) (NS). Life-table analysis of the late results of the 115 elderly patients revealed cumulative survival rates of 85.4% and 63.8% at 2 and 5 years, respectively. The principal causes of late death were cardiac (48%), cancer (15%), and stroke (9%). The cumulative incidence of freedom from stroke in survivors at 2 and 5 years was 98% and 87%, respectively. No relationship between age and operative mortality or perioperative stroke morbidity in the performance of carotid endarterectomy was found in this study.