CAROTID SURGERY IN OCTOGENARIANS - IS IT WORTHWHILE

Controversy surrounds the role of carotid endarterectomy in octogenari ans. Although the prognosis of severe degree carotid stenosis is more ominous in the elderly, operative risk seems more important in the age d. To evaluate the presumed detrimental effect of advanced age on the mortality-morbidity of carotid endarterectomy, the authors reviewed th eir common experience with carotid surgery in patients aged 80 years o r more. From 1980 to 1994, 129 octogenarians were operated on for occl usive carotid artery disease in two university hospitals. The data for these patients, 80 years of age and older (group 1) are compared to t hese for a large middle age group (less than 80 years) (group 2) opera ted by the same surgeons during that period. The baseline characterist ics of both groups were similar, except for smoking, diabetes and prev ious myocardial revascularization, more prevalent in the younger age g roup. In the elderly group prophylactic surgery for asymptomatic steno sis was done in 36%, versus 40% of the middle aged patients, and for s troke in evolution in 8% versus 4% (p < 0.05). The perioperative strok e rate was 0.8% in the group older than 80 years, compared to 1.2% for non octogenarians (NS). The operative mortality was similar for both age groups (2.3 and 1.5 respectively). The long-term results gave a si milar outlook for both age groups. The 5-year stroke-free rate reached 89% for group 1 versus 91% for group 2. The 5-year survival rate, how ever, was less for the elderly patients (47% versus 77%, mean follow-u p periods of 30 and 49 months). These results suggest that carotid end arterectomy can be safely done in elderly patients, with a similar ris k/benefit ratio as for the younger patients. Advanced age, by itself, is not to be considered as contraindication to carotid surgery.