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The Benefits of Carotid Endarterectomy in the Octogenarian: A Challenge to the Results of Carotid Angioplasty and Stenting

The Benefits of Carotid Endarterectomy in the Octogenarian: A Challenge to the Results of Carotid... Proponents of carotid angioplasty and stenting (CAS) believe that this technique would be preferred over carotid endarterectomy (CEA) for the high-risk patient. Presumably this would include patients over 80 years of age. However, a recent large series of patients undergoing CAS revealed a 16% incidence of nonfatal strokes and deaths for patients over the age of 80; these results were significantly worse than those for younger patients undergoing CAS. The objective of this study was to reassess results of CEA in patients over 80, and to compare surgical results with the published results of CAS in this patient group. A review was conducted of a prospectively maintained database of all carotid surgery performed at our institution. Primary CEA that took place from 1997 through 1999 were included for analysis (n = 698). Our institutional results were compared with representative results from a recently published large series of CAS. Our analysis showed that CEA can be performed safely in the octogenarian, and results are equivalent to those of younger patients. CEA appears to have significantly better results in the octogenarian than CAS. The reasons for the poor outcomes of CAS in the octogenarian are unclear. The results of CAS in the older patient population are worrisome, and this "less invasive" technique may prove to be an inferior alternative in this patient group. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Vascular Surgery Springer Journals

The Benefits of Carotid Endarterectomy in the Octogenarian: A Challenge to the Results of Carotid Angioplasty and Stenting

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References (35)

Publisher
Springer Journals
Copyright
Copyright © Inc. by 2003 Annals of Vascular Surgery
Subject
Medicine & Public Health; Abdominal Surgery
ISSN
0890-5096
eISSN
1615-5947
DOI
10.1007/s10016-001-0330-2
pmid
12522696
Publisher site
See Article on Publisher Site

Abstract

Proponents of carotid angioplasty and stenting (CAS) believe that this technique would be preferred over carotid endarterectomy (CEA) for the high-risk patient. Presumably this would include patients over 80 years of age. However, a recent large series of patients undergoing CAS revealed a 16% incidence of nonfatal strokes and deaths for patients over the age of 80; these results were significantly worse than those for younger patients undergoing CAS. The objective of this study was to reassess results of CEA in patients over 80, and to compare surgical results with the published results of CAS in this patient group. A review was conducted of a prospectively maintained database of all carotid surgery performed at our institution. Primary CEA that took place from 1997 through 1999 were included for analysis (n = 698). Our institutional results were compared with representative results from a recently published large series of CAS. Our analysis showed that CEA can be performed safely in the octogenarian, and results are equivalent to those of younger patients. CEA appears to have significantly better results in the octogenarian than CAS. The reasons for the poor outcomes of CAS in the octogenarian are unclear. The results of CAS in the older patient population are worrisome, and this "less invasive" technique may prove to be an inferior alternative in this patient group.

Journal

Annals of Vascular SurgerySpringer Journals

Published: Feb 15, 2003

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