CAROTID ENDARTERECTOMY IN YOUNG-ADULTS - IS IT A WORTHWHILE PROCEDURE

Purpose: The aim of the study was to investigate surgical indication a nd long-term outcome of carotid endarterectomy (CE) in young adults. M ethods: Between 1973 and 1990, 1693 patients underwent CE. Forty-nine patients (group 1) 35 to 45 years of age who had carotid artery stenos is greater than 70%, formed the basis for the analysis. They were comp ared with two additional groups of patients older than 45 years of age selected from the entire series. Group 2 was randomly chosen to deter mine differences in risk factors, associated diseases, operative indic ations, preoperative finding, and outcome. Group 3 was matched with pa tients in group 1 for sex, risk factors, associated diseases, preopera tive findings, and operative indications to assess the importance of a ge in determining the short- and long-term outcome of CE. Results: Pos toperative mortality, cerebrovascular accidents, and cardiac complicat ions in patients of group 1 (2%, 2%, and 2%, respectively) were simila r to those of the other groups (p = NS). During the follow-up (76.7 +/ - 3.6 months; range, 1 to 120 months) the incidence of strokes and tra nsient ischemic attacks in group 1 was lower than in group 2 (p < 0.05 ) but similar to group 3 (P = NS). Ten-year disease-free intervals wer e 75.7%, 58.7%, and 77.6%, respectively, for groups 1, 2, and 3. Morta lity rate unrelated to cerebrovascular disease was similar between gro up 1 and group 3 (P = NS) but was higher in group 1 than in group 2 (p < 0.02). Ten-year survival rates were 46.1%, 71.7%, and 55.5%, respec tively, for group 1, 2, and 3. Conclusions: CE in patients younger tha n 45 years of age is a safe procedure with low operative risks and goo d disease-free intervals. However, life expectancy is poor because of the high incidence of deaths resulting from complications of atheroscl erosis.