CAROTID ENDARTERECTOMY IN THE VERY ELDERLY - IS IT WORTHWHILE

Background. Stroke continues to be the third leading cause of death in this country, its incidence and corresponding mortality rate increase with age, and in the majority of cases its results from arteriosclero sis of the carotid artery. Although recent studies have clearly shown the benefit of carotid endarterectomy in reducing the incidence of str oke, performance of this procedure in very elderly patients, the patie nt population for whom it should be most beneficial, has been challeng ed by some investigators on the basis of perceived increased operative risk. Methods. The records of all carotid endarterectomies (n = 63) p erformed during the last 12 years for all patients (n = 59) with a min imum age of 75 years were reviewed to define the short-term risk of op erative mortality, stroke and other major complications, and the long- term outcome. Results. No (0%) operative deaths and three (4.8%) perio perative strokes occurred. Major cardiac complications occurred in fiv e cases (7.9%). Follow-up, ranging from 1 to 122 months (mean, 27.4 mo nths), was available for 54 patients (91.5%). Cumulative freedom from stroke was 92% at 2 years and 80% at 5 and 10 year of follow-up. Long- term survival rate was 80% at 5 years and 52% at 10 years, and stroke- free survival rate was 68% at 5 years and 42% at 10 years of follow-up . Conclusions. Carotid endarterectomy can be performed in very elderly patients with low operative risk and excellent long-term results.