Between May 1995 and April 1998 three vascular surgeons performed 310 consecutive primary carotid endarterectomies (CEAs) in a 224-bed community hospital. Seventy-six CEAs were performed in octogenarians (Group 1) and 234 CEAs were performed in nonoctogenarians (Group 2). Demographic information, indication for surgery, and outcomes were compared. There were no strokes or deaths in Group 1; there was a single death and three strokes in Group 2. The overall rates of death, stroke, and combined stroke and death were 0.3%, 1%, and 1% respectively. No statistically significant difference existed in rates of morbidity and mortality in Groups 1 and 2. On follow-up (mean = 18 months), 94% of the patients were alive without stroke, 5% were dead, and 1% were alive with stroke. These data demonstrate that CEA can be performed safely in the octogenarian in the community hospital setting.
Get full access to this article
View all access options for this article.
References
1.
1. North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with highgrade stenosis. N Engl J Med325:445-453, 1991.
2.
2. Executive Committee for Asymptomatic Carotid Atherosclerosis Study: Endarterectomy for asymptomatic carotid artery stenosis. JAMA273:1421-1426, 1995.
3.
3. European Carotid Surgery Trialists' Collaborative Group: European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet337:1235-1243, 1991.
4.
4. Barnett, HJM, Taylor DW, Eliaszi M, et al: Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Endarterectomy Trail Collaborators. N Engl J Med329:1415-1425, 1998.
5.
5. Karp HR, Flanders WD, Shipp CC, et al: Carotid endarterectomy among Medicare beneficiaries: A statewide evaluation of appropriateness and outcome. Stroke29:46-52, 1998.
6.
6. Buchbinder D, Golueke PJ, Melick CF, et al: Outcome of carotid endarterectomy performed at a community medical center. Ann Vasc Surg8:427-433, 1994.
7.
7. Easton JD, Sherman DG: Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke8:565-568, 1977.
8.
8. Mattos MA, Modi JR, Mansour MA, et al: Evolution of carotid endarterectomy in two community hospitals: Springfield revisited, 17 years and 2,243 operations later. J Vasc Surg21:719-728, 1995.
9.
9. Hertzer NR, O'Hara PJ, Mascha EJ, et al: Early outcome assessment for 2,228 consecutive carotid endarterectomy procedures: The Cleveland Clinic experience from 1989 to 1995. J Vasc Surgery26:1-10, 1997.
10.
10. Hoyne RF: Review of 272 consecutive carotid endarterectomies in a smaller community. Surg Gynecol Obstet170:522-526, 1990.
11.
11. Carolei A, Marini C, Di Napoli M, et al: High stroke incidence in the prospective community-based L'Aquila registry (1974-1998). First year's results. Stroke282500-2506, 1997.
12.
12. Du X, Sourbutts J, Cruickshank K, et al: A community-based stroke register in a high-risk area for stroke in Northwest England. J Epidemiol Community Health5:472-478, 1997.
13.
13. Kazmners A, Perkins AJ, Huber TS, et al: Journal of surgical research carotid surgery in octogenarians in Veterans Affairs medical centers. 81:87-90, 1999.
14.
14. Manton KG, Vaulp JW: Survival after the age of 80 in the United States, Sweden, France, England, and Japan. N Engl J Med333:1232-1235, 1998.
15.
15. Cronenwett JL, Birkmeyer JD, Nackman GB, et al: Cost-effectiveness of carotid endarterectomy in asymptomatic patients. J Vasc Surg25:293-311, 1997.
16.
16. Meyer FB, Meissner I, Fode NC, et al: Carotid endarterectomy in elderly patients. Mayo Clin Proc66:464-469, 1991.
17.
17. Favre JP, Guy JM, Frering V, et al: Carotid surgery in the octogenarian. Ann Vasc Surg8:421-426, 1994.
18.
18. O'Hara PJ, Hertzer NR, Mascha EJ, et al: Carotid endarterectomy in octogenarians: Early results and late outcome. J Vasc Surg27:860-871, 1998.
19.
19. Pinkerton JA, Gholkar VR: Should patient age be a consideration in carotid endarterectomy?J Vasc Surg11:650-658, 1990.
20.
20. Perler BA: The impact of advanced age on the results of carotid endarterectomy: An outcome analysis. J Am Coll Surg183:559-564, 1996.
21.
21. Coyle KA, Smith RB, Salam AA, et al: Carotid endarterectomy in the octogenarian. Ann Vasc Surg8:417-420, 1994.
22.
22. Taylor DC, Strandness DE Jr: Carotid artery duplex scanning. J Clin Ultrasound15:635-644, 1987.
23.
23. Moneta GL, Edwards JM, Chitwood RW, et al: Correlation of NASCET definition of 70-90% internal carotid artery stenosis with duplex scanning. J Vasc Surg17:152-159, 1993.
24.
24. Beebe HG, Clagett GP, DeWeese JA, et al: Assessing risk associated with carotid endarterectomy: A statement of health professionals by an ad hoc comnmittee on carotid surgery standards of the stroke council, American Heart Association. Circulation79:472-473, 1989.
25.
25. Hsia DC, Krushat WM, Moscoe LM: Epidemiology of carotid endarterectomies among Medicare beneficiaries. J Vasc Surg16:201-208, 1992.
26.
26. Riles TS, Fisher ES, Lamparello PJ, et al: Immediate and long-term results of carotid endarterectomy for asymptomatic high-grade stenosis. Ann Vasc Surg8:144-149, 1994.
27.
27. Giangola G, Migaly J, Riles TS, et al: Perioperative morbidity and mortality in combined vs staged approaches to carotid and coronary revascularization. Ann Vasc Surg10:138-142, 1996.
28.
28. Johnson BF, Verlato F, Bergelin RO, et al: Clinical outcome in patients with mild and moderate carotid artery stenosis. J Vasc Surg21:120-1261995.
29.
29. Rockman CB, Riles TS, Lamparello PJ, et al: Natural history and management of the asymptomatic moderately stenotic internal carotid artery. J Vasc Surg25:423-431, 1997.
30.
30. Mansour MA, Mattos MA, Faught WE, et al: The natural history of moderate (50% to 79%) internal carotid artery stenosis in symptomatic, nonhemispheric, and asymptomatic patients. J Vasc Surg21:346-357, 1995.
31.
31. Lynch J, Kaplan GA, Salonen R, et al: Socioeconomic status and carotid atherosclerosis. Circulation92:1786-1792, 1995.
