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Evaluation and comparison of postoperative outcomes of octogenarians and non-octogenarians undergoing carotid endarterectomy

  • Serkan Burç DeşerEmail author
  • Mustafa Kemal Demirag
  • Fersat Kolbakir
  • Semih Murat Yucel
  • Murat Muzaffer Güçlü
  • Merve Polat
  • Hasan Tahsin Keceligil
original article
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Summary

Introduction

The aim of this study was to compare and evaluate the postoperative outcomes of carotid endarterectomy (CEA) in symptomatic and asymptomatic octogenarians and younger patients in a single institution, if octogenarians are eligible for CEA.

Methods

A total of 190 patients (149 males, 41 females; mean age 69.59 ± 9.87 years; range 47 to 92 years) who underwent eversion or conventional CEA with patchplasty, under general or local anesthesia, were included in this study.

Results

No statistically significant difference was found in terms of postoperative death (p = 1), postoperative stroke (p = 0.592), and postoperative bleeding (p = 0.659), while blood creatinine level was significantly higher in octogenarians. Postoperative stroke and death were seen in none of the octogenarians, although 4 postoperative deaths and 6 major strokes were seen among non-octogenarians. No difference was found in females (octogenarians vs. non-octogenarians) in terms of death (p = 1.00) and stroke (p = 1.00) and no difference was found in males (octogenarians vs. non-octogenarians) in terms of death (p = 1.00) and stroke (p = 1.00).

Conclusion

We thought that CEA remains the most efficient treatment modality among symptomatic and asymptomatic octogenarians with severe carotid artery stenosis and no difference was found compared to non-octogenarians. Advanced age should not be considered as a high-risk group and selected octogenarians are good candidates for CEA.

Keywords

Carotid artery Endarterectomy Octogenarians Stroke Death 

Notes

Conflict of interest

S.B. Deşer, M.K. Demirag, F. Kolbakir, S.M. Yucel, M.M. Güçlü, M. Polat, and H.T. Keceligil declare that they have no competing interests.

References

  1. 1.
    Miller MT, Comerota AJ, Tzilinis A, Daoud Y, Hammerling J. Carotid endarterectomy in octogenarians: Does increased age indicate “high risk?”. J Vasc Surg. 2005;41:231–7.CrossRefGoogle Scholar
  2. 2.
    Hobson RW, Howard VJ, Roubin GS, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40(6):1106–11.CrossRefGoogle Scholar
  3. 3.
    Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325:445–53.CrossRefGoogle Scholar
  4. 4.
    Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A. Editor’s choice e management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55:3–81.CrossRefGoogle Scholar
  5. 5.
    Rajamani K, Kennedy KF, Ruggiero NJ, Rosenfield K, Spertus J, Chaturvedi S. Outcomes of carotid endarterectomy in the elderly. Report from the National Cardiovascular Registry. Stroke. 2013;44:1172–4.CrossRefGoogle Scholar
  6. 6.
    Manolio TA, Kronmal RA, Burke GL, et al. Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke. 1996;27:1479–86.CrossRefGoogle Scholar
  7. 7.
    Schneider JR, Droste JS, Schindler N, Golan JF. Carotid endarterectomy in octogenarians: comparison with patient characteristics and outcomes in younger patients. J Vasc Surg. 2000;31(5):927–35.CrossRefGoogle Scholar
  8. 8.
    Marini C, Baldassarre M, Russo T, et al. Burden of first-ever ischemic stroke in the oldest old. Evidence from a population-based study. Baillieres Clin Neurol. 2004;62:77–81.Google Scholar
  9. 9.
    Kammersgaard LP, Jorgensen HS, Reith J, et al. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing. 2004;33:149–54.CrossRefGoogle Scholar
  10. 10.
    van Reichmann BL, van Lammeren GW, Moll FL, de Borst GJ. Is Age of 80 years a threshold for carotid revascularization? Curr Cardiol Rev. 2011;7:15–21.CrossRefGoogle Scholar
  11. 11.
    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Executive committee for the asymptomatic carotid atherosclerosis study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–8.CrossRefGoogle Scholar
  12. 12.
    MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet. 2004;363:1491–502.CrossRefGoogle Scholar
  13. 13.
    Aichner FT, Topakian R, Alberts MJ, Bhatt DL, Haring HP, Hill MD, REACH Registry Investigators. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry. Eur J Neurol. 2009;16:902–8.CrossRefGoogle Scholar
  14. 14.
    Luebke T, Brunkwall J. Development of a Microsimulation model to predict stroke and long-term mortality in adherent and nonadherent medically managed and surgically treated octogenarians with asymptomatic significant carotid artery stenosis. World Neurosurg. 2016;92:513–20.CrossRefGoogle Scholar
  15. 15.
    Ballotta E, Toniato A, Da Roit A, Lorenzetti R, Piatto G, Baracchini C. Carotid endarterectomy for asymptomatic carotid stenosis in the very elderly. J Vasc Surg. 2015;61:382–8.CrossRefGoogle Scholar
  16. 16.
    Fantozzi C, Taurino M, Rizzo L, Stella N, Persiani F. Carotid Endarterectomy or stenting in octogenarians in a monocentric experience. Ann Vasc Surg. 2016;33:132–7.CrossRefGoogle Scholar
  17. 17.
    Okawa M, Ogata T, Abe H, Fukuda K, Higashi T, Inoue T. Do octogenarians still have a high risk of adverse outcomes after carotid endarterectomy in the era of a super-aged society? A single-center study in Japan. J Stroke Cerebrovasc Dis. 2015;24:370–3.CrossRefGoogle Scholar
  18. 18.
    Pol RA, Reijnen MM, Lont M, Tielliu IF, van Sterkenburg SM, van den Dungen JJ, Zeebregts CJ. Safety and efficacy of carotid endarterectomy in octogenarians. Ann Vasc Surg. 2013;27(6):736–42.CrossRefGoogle Scholar
  19. 19.
    Almekhlafi MA, Couillard PL, Pandya A, Shobha N, Morrish WF, Wong JHH. Outcomes after carotid angioplasty and stenting in symptomatic octogenarians. Can J Neurol Sci. 2011;38(3):446–51. May.CrossRefGoogle Scholar
  20. 20.
    Norman PE, Semmens JB, Laurvick CL, Lawrence-Brown M. Long-term relative survival in elderly patients after carotid endarterectomy: a population-based study. Stroke. 2003;34(7):e95–8.CrossRefGoogle Scholar
  21. 21.
    Kueh SH, Livingstone V, Thomson IA. Carotid endarterectomy in octogenarians. N Z Med J. 2012;125(1364):77–82.PubMedGoogle Scholar
  22. 22.
    Davies KJ, Thapar A, Kasivisvanathan V, Shalhoub J, Davies AH. Review of trans-Atlantic cardiovascular best medical therapy guidelinesdrecommendations for asymptomatic carotid atherosclerosis. Curr Vasc Pharmacol. 2013;11:514–23.CrossRefGoogle Scholar
  23. 23.
    Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004;363(9413):915–24.CrossRefGoogle Scholar
  24. 24.
    Chaturvedi S, Matsumura JS, Gray W, et al. Carotid artery stenting in octogenarians: periprocedural stroke risk predictor analysis from the multicenter Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) clinical trial. Stroke. 2010;41:757–64.CrossRefGoogle Scholar
  25. 25.
    Usman AA, Tang GL, Eskandari MK. Metaanalysis of procedural stroke and death among octogenarians: carotid stenting versus carotid endarterectomy. J Am Coll Surg. 2009;208(6):1124–31.CrossRefGoogle Scholar
  26. 26.
    Mantese VA, Timaran CH, Chiu D, al Investigators C. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010;41:S31–S4.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular Surgery, School of MedicineOndokuz Mayis UniversitySamsunTurkey

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