Carotid artery stenting in octogenarians

Is it too risky?

G Matthew Longo, Melina R. Kibbe, Mark K. Eskandari

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Recent clinical trials have shown that the safety of carotid angioplasty and stenting (CAS) is equivalent to that of carotid endarterectomy (CEA) in high-risk patients. Despite this, the beneficial outcome in octogenarians has come under scrutiny in light of the interim results of the Carotid Artery Revascularization versus Stent Trial (CREST). We report on a single-center experience of patients ≥80 years of age compared to younger cohorts treated with CAS. CAS procedures, performed exclusively by vascular surgeons, from April 2001 to December 2004 were retrospectively reviewed. Mechanical cerebral protection with either a distal balloon occlusion system or a distal filter device was used in 140 cases and in all patients ≥80 years of age. Patients were divided into age categories: <60, 60-69, 70-79, and ≥80 years old. Data analysis included patient demographics, perioperative death, myocardial infarction, stroke, and other major complications. Statistics were derived using the SPSS program. A total of 158 procedures were performed on 151 patients. There were no statistical differences among the four groups with respect to mean stenosis or the presence of preoperative symptoms. Rates of stroke were 1 of 16 (6.25%) <60 years old, 0 of 54 (0%) age 60-69, 2 of 59 (3.4%) age 70-79, and 1 of 29 (3.4%) ≥80 years old. Preoperative symptoms were present in 6 of 29 (21%) patients ≥80 years old. Myocardial infarction and mortality rates were 0% for all groups. There were no statistical differences in stroke, death, or nonneurological complication rates among the four groups. Vascular surgeons facile at CAS should expect 30-day results comparable to CEA in all age groups. Octogenarians, whether symptomatic or asymptomatic, should not be denied this form of treatment.

Original languageEnglish (US)
Pages (from-to)812-816
Number of pages5
JournalAnnals of Vascular Surgery
Volume19
Issue number6
DOIs
StatePublished - Jan 1 2005

Fingerprint

Carotid Arteries
Angioplasty
Carotid Endarterectomy
Stroke
Blood Vessels
Myocardial Infarction
Balloon Occlusion
Stents
Pathologic Constriction
Age Groups
Demography
Clinical Trials
Safety
Equipment and Supplies
Mortality

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Carotid artery stenting in octogenarians : Is it too risky? / Longo, G Matthew; Kibbe, Melina R.; Eskandari, Mark K.

In: Annals of Vascular Surgery, Vol. 19, No. 6, 01.01.2005, p. 812-816.

Research output: Contribution to journalArticle

Longo, G Matthew ; Kibbe, Melina R. ; Eskandari, Mark K. / Carotid artery stenting in octogenarians : Is it too risky?. In: Annals of Vascular Surgery. 2005 ; Vol. 19, No. 6. pp. 812-816.
@article{a267798751324562a697d128af8eb9db,
title = "Carotid artery stenting in octogenarians: Is it too risky?",
abstract = "Recent clinical trials have shown that the safety of carotid angioplasty and stenting (CAS) is equivalent to that of carotid endarterectomy (CEA) in high-risk patients. Despite this, the beneficial outcome in octogenarians has come under scrutiny in light of the interim results of the Carotid Artery Revascularization versus Stent Trial (CREST). We report on a single-center experience of patients ≥80 years of age compared to younger cohorts treated with CAS. CAS procedures, performed exclusively by vascular surgeons, from April 2001 to December 2004 were retrospectively reviewed. Mechanical cerebral protection with either a distal balloon occlusion system or a distal filter device was used in 140 cases and in all patients ≥80 years of age. Patients were divided into age categories: <60, 60-69, 70-79, and ≥80 years old. Data analysis included patient demographics, perioperative death, myocardial infarction, stroke, and other major complications. Statistics were derived using the SPSS program. A total of 158 procedures were performed on 151 patients. There were no statistical differences among the four groups with respect to mean stenosis or the presence of preoperative symptoms. Rates of stroke were 1 of 16 (6.25{\%}) <60 years old, 0 of 54 (0{\%}) age 60-69, 2 of 59 (3.4{\%}) age 70-79, and 1 of 29 (3.4{\%}) ≥80 years old. Preoperative symptoms were present in 6 of 29 (21{\%}) patients ≥80 years old. Myocardial infarction and mortality rates were 0{\%} for all groups. There were no statistical differences in stroke, death, or nonneurological complication rates among the four groups. Vascular surgeons facile at CAS should expect 30-day results comparable to CEA in all age groups. Octogenarians, whether symptomatic or asymptomatic, should not be denied this form of treatment.",
author = "Longo, {G Matthew} and Kibbe, {Melina R.} and Eskandari, {Mark K.}",
year = "2005",
month = "1",
day = "1",
doi = "10.1007/s10016-005-7977-z",
language = "English (US)",
volume = "19",
pages = "812--816",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Carotid artery stenting in octogenarians

T2 - Is it too risky?

AU - Longo, G Matthew

AU - Kibbe, Melina R.

AU - Eskandari, Mark K.

PY - 2005/1/1

Y1 - 2005/1/1

N2 - Recent clinical trials have shown that the safety of carotid angioplasty and stenting (CAS) is equivalent to that of carotid endarterectomy (CEA) in high-risk patients. Despite this, the beneficial outcome in octogenarians has come under scrutiny in light of the interim results of the Carotid Artery Revascularization versus Stent Trial (CREST). We report on a single-center experience of patients ≥80 years of age compared to younger cohorts treated with CAS. CAS procedures, performed exclusively by vascular surgeons, from April 2001 to December 2004 were retrospectively reviewed. Mechanical cerebral protection with either a distal balloon occlusion system or a distal filter device was used in 140 cases and in all patients ≥80 years of age. Patients were divided into age categories: <60, 60-69, 70-79, and ≥80 years old. Data analysis included patient demographics, perioperative death, myocardial infarction, stroke, and other major complications. Statistics were derived using the SPSS program. A total of 158 procedures were performed on 151 patients. There were no statistical differences among the four groups with respect to mean stenosis or the presence of preoperative symptoms. Rates of stroke were 1 of 16 (6.25%) <60 years old, 0 of 54 (0%) age 60-69, 2 of 59 (3.4%) age 70-79, and 1 of 29 (3.4%) ≥80 years old. Preoperative symptoms were present in 6 of 29 (21%) patients ≥80 years old. Myocardial infarction and mortality rates were 0% for all groups. There were no statistical differences in stroke, death, or nonneurological complication rates among the four groups. Vascular surgeons facile at CAS should expect 30-day results comparable to CEA in all age groups. Octogenarians, whether symptomatic or asymptomatic, should not be denied this form of treatment.

AB - Recent clinical trials have shown that the safety of carotid angioplasty and stenting (CAS) is equivalent to that of carotid endarterectomy (CEA) in high-risk patients. Despite this, the beneficial outcome in octogenarians has come under scrutiny in light of the interim results of the Carotid Artery Revascularization versus Stent Trial (CREST). We report on a single-center experience of patients ≥80 years of age compared to younger cohorts treated with CAS. CAS procedures, performed exclusively by vascular surgeons, from April 2001 to December 2004 were retrospectively reviewed. Mechanical cerebral protection with either a distal balloon occlusion system or a distal filter device was used in 140 cases and in all patients ≥80 years of age. Patients were divided into age categories: <60, 60-69, 70-79, and ≥80 years old. Data analysis included patient demographics, perioperative death, myocardial infarction, stroke, and other major complications. Statistics were derived using the SPSS program. A total of 158 procedures were performed on 151 patients. There were no statistical differences among the four groups with respect to mean stenosis or the presence of preoperative symptoms. Rates of stroke were 1 of 16 (6.25%) <60 years old, 0 of 54 (0%) age 60-69, 2 of 59 (3.4%) age 70-79, and 1 of 29 (3.4%) ≥80 years old. Preoperative symptoms were present in 6 of 29 (21%) patients ≥80 years old. Myocardial infarction and mortality rates were 0% for all groups. There were no statistical differences in stroke, death, or nonneurological complication rates among the four groups. Vascular surgeons facile at CAS should expect 30-day results comparable to CEA in all age groups. Octogenarians, whether symptomatic or asymptomatic, should not be denied this form of treatment.

UR - http://www.scopus.com/inward/record.url?scp=27644505580&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=27644505580&partnerID=8YFLogxK

U2 - 10.1007/s10016-005-7977-z

DO - 10.1007/s10016-005-7977-z

M3 - Article

VL - 19

SP - 812

EP - 816

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

IS - 6

ER -