CAROTID ENDARTERECTOMY IN PATIENTS 75 YEA RS AND OLDER

To evaluate the role of carotid surgery in elderly patients 75 years a nd older, we reviewed 912 carotid endarterectomies performed on 806 pa tients between 1987 and 1990. There were 151 patients (19 % of the who le series) aged 75 years and older (160 endarterectomies, group A), in cluding 29 octogenarians, vs 655 patients under 75 years of age (group B). There were more women in the elderly age groupe (44 %) than in th e younger one (38 %). Symptoms, risk factors, operative outcome and fo llow up data of the two groups were compared. The risk profile was sim ilar for the two age groups, with exception for coronary heart disease , less frequent in the older patient group (25 % had previous infarcti on vs 44 %). Indication for carotid endarterectomy was different in th e two age groups : 41 % of group A underwent prophylactic thrombendart erectomy for high degree stenosis, while only 30 % of group B had asym ptomatic carotid disease. In group A, 6 % of the patients had carotid endarterectomy after recovering from a mild stroke, vs 2 % in group B. Angiography revealed bilateral carotid disease in 59 % of the group A patients (including 15 % with controlateral occlusion) vs 40 % in gro up B. Operative mortality was 1.5 % for the younger age group vs 2.5 % for the older age group. The cause of death was cardiac in 60 %. A fo llow up is available for all patients who benefited carotid endarterec tomy since 1976, including 180 patients aged 75 years or older. The lo ng-term follow-up ranged from 6 months to 12 years (mean 5 years). The 5 year survival rate is 65 % for group A patients. Cardiac disease wa s the most common cause of late death. Most of the survivors remained stroke free (5 years stroke incidence of 7.5 %, with half of the late neurologic events occurring at the non operated side). The authors con clude that carotid endarterectomy in patient 75 years and older remain s valuable as a stroke proventing procedure, with an acceptable combin ed stroke-mortality rate (J Mal Vasc, 1993, 18, pp. 245-253).