ENTERING THE 9TH DECADE IS NOT A CONTRAINDICATION FOR CAROTID ENDARTERECTOMY

The role of carotid endarterectomy (CEA) in stroke prevention is now b etter defined. However, its role in patients older than 79 years of ag e is controversial. This group of patients has been excluded in most c linical trials. In this study the authors reviewed their experience wi th CEA patients >79 years old. The records of all patients older than 79 years of age who underwent a CEA in a recent time period from Janua ry 1988 to December 1996 were retrospectively reviewed. Forty-one pati ents (31 men, 10 women) were identified by computer search. The indica tion for operation included transient ischemic attack in 12 (29.3%), a maurosis fugax in nine (22%), stroke in two (4.9%), and nonhemispheric symptoms in three (7.3%). Fifteen patients (36.6%) were asymptomatic. Medical risk factors included coronary artery disease in 26 (63.4%), hypertension in 22 (53.7%), and smoking in 12 (29.3%). The procedure w as performed under EEG monitoring in all patients. General anesthesia was administered in 37 (90%) and regional anesthesia in four (10%). Sh unts were used in four (10%) patients. The internal carotid artery was patched in 16 patients (39%). One patient (2.4%) developed a perioper ative stroke and only one patient developed perioperative myocardial i nfarction (MI). None of the patients died within 30 days of surgery. I n addition to the one MI case, five patients developed minor complicat ions. The average length of time for stay after CEA was 3.4 days. Pati ents were followed up for an average of 20.7 months. Six patients died during follow-up. Four of those died from an MI and two from a stroke . The authors conclude that with proper selection of patients, CEA is safe in the octogenarian. Age alone should not be a contraindication f or CEA.