Journal of Vascular Surgery
Volume 50, Issue 3 , Pages 518-525 , September 2009

Early and long-term outcomes of carotid endarterectomy in the very elderly: An 18-year single-center study

  • Enzo Ballotta, MD

      Affiliations

    • Vascular Surgery Section, Geriatric Surgery Clinic; Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy
    • Corresponding Author InformationReprint requests: Enzo Ballotta, MD, Vascular Surgery Section, Geriatric Surgery Clinic; Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Via N. Giustiniani, 2 35128 Padova, Italy
  • ,
  • Giuseppe Da Giau, MD

      Affiliations

    • Vascular Surgery Section, Geriatric Surgery Clinic; Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy
  • ,
  • Mario Ermani, MD

      Affiliations

    • Department of Neurological Sciences, University of Padua, School of Medicine, Padua, Italy
  • ,
  • Giorgio Meneghetti, MD

      Affiliations

    • Department of Neurological Sciences, University of Padua, School of Medicine, Padua, Italy
  • ,
  • Marina Saladini, MD

      Affiliations

    • Department of Neurological Sciences, University of Padua, School of Medicine, Padua, Italy
  • ,
  • Renzo Manara, MD

      Affiliations

    • Department of Neurological Sciences, University of Padua, School of Medicine, Padua, Italy
  • ,
  • Claudio Baracchini, MD

      Affiliations

    • Department of Neurological Sciences, University of Padua, School of Medicine, Padua, Italy

Received 19 March 2009 ,Accepted 20 April 2009.

References 

  1. Tables of mortality. http://demo.istat.itAccessed on January 24, 2009
  2. Giannakouris K. Eurostat (Statistics in focus. Population and social conditions). http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-SF-08-072/EN/KS-SF-08-072-EN.PDFAccessed on February 3, 2009
  3. Jemal A, Ward E, Hao Y, Thun M. Trends in the causes of death in the United States, 1970-2002. JAMA. 2005;294:1255–1259
  4. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–453
  5. European Carotid Surgery Trialists Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet. 1991;337:1235–1243
  6. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–1428
  7. 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;363:1491–1502
  8. Roubin GS, New G, Iyer SS, Vitek JJ, Al-Mubarak N, Liu MW, et al. Immediate and late clinical outcome of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis. Circulation. 2001;103:532–537
  9. Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke. 2003;34:813–819
  10. Stanziale SF, Marone LK, Boules TN, Brimmeier JA, Hill K, Makaroun MS, et al. Carotid artery stenting in octogenarians is associated with increased adverse outcomes. J Vasc Surg. 2006;43:297–304
  11. Zahn R, Ischinger T, Hochadel M, Zeymer U, Schmalz W, Treese N, et al. Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (Carotid artery stenting in octogenarians: results from the ALKK Carotid Artery Stent (CAS) Registry). Eur Heart J. 2007;28:370–375
  12. Ballotta E, Da Giau G, Gruppo M, Meneghetti G, Manara R, Ermani M, et al. Diabetes and asymptomatic carotid lesion: does diabetic disease influence the outcome of carotid endarterectomy? (A 10-year single center experience). Surgery. 2008;143:519–525
  13. Ballotta E, Da Giau G, Saladini M, Abbruzzese E, Renon L, Toniato A. Carotid endarterectomy with patch closure vs carotid eversion endarterectomy and reimplantation (A prospective randomized study). Surgery. 1999;125:271–279
  14. Ballotta E, Da Giau G. Selective shunting with eversion carotid endarterectomy. J Vasc Surg. 2003;38:1045–1050
  15. van Swieten JC, Kondstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–607
  16. Baker JD, Rutherford RB, Bernstein EF, Courbier R, Ernst CB, Kempczinski RF, et al. Suggested standards for reports dealing with cerebrovascular disease. J Vasc Surg. 1988;8:721–729
  17. Brenner H, Hakulinen T. On crude and age-adjusted relative survival rates. J Clin Epidemiol. 2003;56:1185–1191
  18. Schultz RD, Sterpetti AV, Feldhaus RJ. Carotid endarterectomy in octogenarians and nonagenarians. Surg Gynecol Obstet. 1988;166:245–251
  19. Pinkerton JA, Gholkar VR. Should patient age be a consideration in carotid endarterectomy?. J Vasc Surg. 1990;11:650–658
  20. Treiman RL, Wagner WH, Foran RF, Cossman DV, Levin PM, Cohen JL, et al. Carotid endarterectomy in the elderly. Ann Vasc Surg. 1992;6:321–324
  21. Coyle CA, Smith RB, Salam AA, Dodson TF, Chaikof EL, Lumsden AB. Carotid endarterectomy in the octogenarian. Ann Vasc Surg. 1994;8:417–420
  22. O'Hara PJ, Hertzer NR, Mascha EJ, Beven EG, Krajewski LP, Sullivan TM. Carotid endarterectomy in octogenarians: early results and late outcome. J Vasc Surg. 1998;27:860–871
  23. Perler BA, Dardik A, Burleyson GP, Gordon TA, Williams GM. Influence of age and hospital volume on the results of carotid endarterectomy: a statewide analysis of 9918 cases. J Vasc Surg. 1998;27:25–33
  24. Ting ACW, Taylor DC, Salvian AJ, Chen JCL, Strandberg S, Hsiang YNH. Carotid endarterectomy in octogenarians. Cardiovasc Surg. 2000;8:441–445
  25. Maxwell JG, Taylor AJ, Maxwell BG, Brinker CC, Covington DL, Tinsley E. Carotid endarterectomy in the community hospital in patients age 80 and older. Ann Surg. 2000;231:781–788
  26. 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;31:927–935
  27. Ozsvath KJ, Darling RC, Tabatabai L, Roddy SP, Paty PS, Chang BB, et al. Carotid endarterectomy in the elderly: does gender effect outcome?. Cardiovasc Surg. 2002;10:534–537
  28. Rockman CB, Jacobowitz GR, Adelman MA, Lamparello PJ, Gagne PJ, Landis R, et al. The benefits of carotid endarterectomy in the octogenarian: a challenge to the results of carotid angioplasty and stenting. Ann Vasc Surg. 2003;17:9–14
  29. Pruner G, Castellano R, Jannello AM, Astore D, Civilini E, Melissano G, et al. Carotid endarterectomy in the octogenarian: outcomes of 345 procedures performed from 1995-2000. Cardiovasc Surg. 2003;11:105–112
  30. Miller MT, Comerota AJ, Tzilinis A, Daoud Y, Hammerling J. Carotid endarterectomy in octogenarians: does increased age indicate “high risk”?. J Vasc Surg. 2005;41:231–237
  31. Stoner MC, Abbott WM, Wong DR, Hua HT, LaMuraglia GM, Kwolek CJ, et al. Defining the high-risk patient for carotid endarterectomy: An analysis of the prospective National Surgical Quality Improvement Program database. J Vasc Surg. 2006;43:285–295
  32. Ballotta E, Renon L, Da Giau G, Barbon B, Terranova O, Baracchini C. Octogenarians with contralateral carotid occlusion: a cohort at higher risk for carotid endarterectomy?. J Vasc Surg. 2004;59:1003–1008
  33. Ballotta E, Da Giau G, Militello C, Barbon B, De Rossi A, Meneghetti G, et al. High-grade symptomatic and asymptomatic carotid stenosis in the very elderly: a challenge for proponents of carotid angioplasty and stenting. BMC Cardiovasc Disord. 2006;6:12
  34. Hobson RW, Howard VJ, Roubin GS, Brott TG, Ferguson RD, Popma JJ, 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;40:1106–1111
  35. McCormick DJ, Vlad T, Fasseas P. Carotid artery stenting will replace carotid endarterectomy. Perspect Vasc Surg Endovasc Ther. 2007;19:223–227
  36. Katzen BT, Criado FJ, Ramee SR, Massop DW, Hopkins LN, Donohoe D, et al. CASES-PMS Investigators Carotid artery stenting with emboli protection surveillance study: thirty-day results of the CASES-PMS study. Catheter Cardiovasc Interv. 2007;70:316–323
  37. Cao P, De Rango P, Zannetti S. Eversion vs conventional carotid endarterectomy: a systematic review. Eur J Vasc Endovasc Surg. 2002;23:195–201
  38. Normann 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:e95–e98

 Competition of interest: none.

PII: S0741-5214(09)00984-7

doi: 10.1016/j.jvs.2009.04.053

Journal of Vascular Surgery
Volume 50, Issue 3 , Pages 518-525 , September 2009