CAROTID STENOSIS AND CORONARY-ARTERY DISEASE IN THE ELDERLY - THE VASCULAR SURGEONS POINT-OF-VIEW

Surgical prevention of stroke is justified only when the perioperative morbidity and mortality rates are very low. Therefore, an accurate ca rdiac evaluation is essential for patients with a vascular disease lik e carotid stenosis, to reduce the surgical risk and improve prognosis. The aim of our retrospective study was to characterize subgroups of p atients with high cardiac risk. From 1986 to 1993 at the Vascular Surg ery Unit of the Department of Surgery and Surgical Emergencies at the University of Perugia, 857 carotid endarterectomies were performed on 739 patients. The stroke/death rate, at 30 days after surgery, was 2.1 6% per patient and 1.86% per procedure; cardiac mortality was 0. Howev er, during follow-up 58 patients died: 55% of these deaths could be at tributed to cardiac disease. No statistically significant differences emerged in cardiac mortality of patients with a positive history of ce rebral vascular accident with respect to asymptomatics, neither among patients with carotid stenosis associated with complete contralateral occlusion nor among those without. Our group of patients had a 76% sur vival rate at 7 years after surgery, which is different from that repo rted by other studies. This may be due to some bias associated with th e preoperative selection of the patients and the retrospective nature of our study. Nevertheless, in patients with carotid stenosis, the mos t important cause of death is cardiac ischemia, therefore a rigorous p reoperative selection is mandatory particularly in elderly asymptomati c patients.