The Management of Carotid Stenoses in the Elderly
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- Frey, P. & Kinlay, S. Curr Cardiovasc Risk Rep (2012) 6: 425. doi:10.1007/s12170-012-0258-9
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Asymptomatic individuals with a significant carotid artery stenosis are at a higher risk of stroke. However, the optimal management strategy of elderly patients with asymptomatic carotid disease is controversial. Medical management with intensive atherosclerosis risk factor modification is the cornerstone of treatment as it decreases both the incidence of stroke and events in other vascular arterial beds (e.g., myocardial infarction). While data support invasive revascularization of carotid artery stenosis in select asymptomatic individuals, the magnitude of benefit in the elderly population beyond optimal medical treatment is less clear. This is due to a higher periprocedural/ perioperative risk of adverse events and a lower life expectancy compared to younger patients. In certain elderly patients with favorable anatomy, procedural risk, and life expectancy, carotid revascularization by endarterectomy or stenting may offer additional benefits beyond intensive medical therapy. Further clinical trials should determine whether revascularization offers benefits beyond optimal medical therapy and whether certain clinical features or non-invasive tests can select those with greater benefits.