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Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes

PURPOSE: Carotid endarterectomy (CEA) has an established effect on stroke-free survival in patients with carotid artery stenosis. Most landmark trials excluded patients ≥80 years of age due to their perceived high risk and uncertainty regarding the benefits of CEA. Despite the ongoing global increas...

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Autores principales: Fahad, Shabin, Shirsath, Sayali, Metcalfe, Matthew, Elmallah, Ahmed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society for Vascular Surgery 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519940/
https://www.ncbi.nlm.nih.gov/pubmed/37748930
http://dx.doi.org/10.5758/vsi.230060
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author Fahad, Shabin
Shirsath, Sayali
Metcalfe, Matthew
Elmallah, Ahmed
author_facet Fahad, Shabin
Shirsath, Sayali
Metcalfe, Matthew
Elmallah, Ahmed
author_sort Fahad, Shabin
collection PubMed
description PURPOSE: Carotid endarterectomy (CEA) has an established effect on stroke-free survival in patients with carotid artery stenosis. Most landmark trials excluded patients ≥80 years of age due to their perceived high risk and uncertainty regarding the benefits of CEA. Despite the ongoing global increase in life expectancy, guidelines have not changed. The current study aimed to assess CEA outcomes in patients ≥80 years of age. MATERIALS AND METHODS: Data from patients ≥80 years of age, who underwent CEA between April 2016 and April 2022, were collected. Demographic information, comorbidities, surgical details, operative details, outcomes, and post-CEA survival were reviewed, and long-term data up to April 2023 were collected. RESULTS: Over the 6-year study period, 258 CEA procedures were recorded, of which 70 (27.1%) were performed in patients ≥80 years of age; the mean age was 84 years (range, 80-96 years), 47 (67.1%) were males, and 69 (98.6%) were symptomatic. Twenty-three (32.9%) patients were American Society of Anesthesiologists (ASA) grade 2, and 47 (67.1%) were grade 3. The 30-day stroke and mortality rates were 4.3% and 1.4%, respectively. At 1, 3, and 5 years, the cumulative freedom-from-stroke rates were 95.7%, 92.9%, and 91.4%, respectively, and the cumulative survival rates were 94.3%, 75.7%, and 61.4%, respectively. No risk factors affected early or late stroke or early mortality rates. Patients with ASA grade 3 had significantly lower cumulative survival than those with grade 2 (HR, 5.29; 95% CI, 1.590-17.603; P<0.01). CONCLUSION: CEA was safe and effective in average-risk, elderly patients. Higher risk patients (i.e., ASA 3) showed no increased 30-day risk for stroke or mortality but exhibited significantly worse long-term survival. Hence, careful consideration of the benefits before performing CEA is crucial.
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spelling pubmed-105199402023-09-27 Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes Fahad, Shabin Shirsath, Sayali Metcalfe, Matthew Elmallah, Ahmed Vasc Specialist Int Original Article PURPOSE: Carotid endarterectomy (CEA) has an established effect on stroke-free survival in patients with carotid artery stenosis. Most landmark trials excluded patients ≥80 years of age due to their perceived high risk and uncertainty regarding the benefits of CEA. Despite the ongoing global increase in life expectancy, guidelines have not changed. The current study aimed to assess CEA outcomes in patients ≥80 years of age. MATERIALS AND METHODS: Data from patients ≥80 years of age, who underwent CEA between April 2016 and April 2022, were collected. Demographic information, comorbidities, surgical details, operative details, outcomes, and post-CEA survival were reviewed, and long-term data up to April 2023 were collected. RESULTS: Over the 6-year study period, 258 CEA procedures were recorded, of which 70 (27.1%) were performed in patients ≥80 years of age; the mean age was 84 years (range, 80-96 years), 47 (67.1%) were males, and 69 (98.6%) were symptomatic. Twenty-three (32.9%) patients were American Society of Anesthesiologists (ASA) grade 2, and 47 (67.1%) were grade 3. The 30-day stroke and mortality rates were 4.3% and 1.4%, respectively. At 1, 3, and 5 years, the cumulative freedom-from-stroke rates were 95.7%, 92.9%, and 91.4%, respectively, and the cumulative survival rates were 94.3%, 75.7%, and 61.4%, respectively. No risk factors affected early or late stroke or early mortality rates. Patients with ASA grade 3 had significantly lower cumulative survival than those with grade 2 (HR, 5.29; 95% CI, 1.590-17.603; P<0.01). CONCLUSION: CEA was safe and effective in average-risk, elderly patients. Higher risk patients (i.e., ASA 3) showed no increased 30-day risk for stroke or mortality but exhibited significantly worse long-term survival. Hence, careful consideration of the benefits before performing CEA is crucial. The Korean Society for Vascular Surgery 2023-09-25 /pmc/articles/PMC10519940/ /pubmed/37748930 http://dx.doi.org/10.5758/vsi.230060 Text en Copyright © 2023, The Korean Society for Vascular Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Fahad, Shabin
Shirsath, Sayali
Metcalfe, Matthew
Elmallah, Ahmed
Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes
title Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes
title_full Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes
title_fullStr Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes
title_full_unstemmed Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes
title_short Carotid Endarterectomy in the Very Elderly: Short-, Medium-, and Long-Term Outcomes
title_sort carotid endarterectomy in the very elderly: short-, medium-, and long-term outcomes
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519940/
https://www.ncbi.nlm.nih.gov/pubmed/37748930
http://dx.doi.org/10.5758/vsi.230060
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