Carotid endarterectomy (surgery to open) or stenting (putting an internal strut in) have always been a very dramatic and sometimes complication producing approaches to obstructed carotids.
The carotids are your front neck arteries and when they get plugged up it impacts circulation to your brain. Not good to have them flip off plaque or obstruct.
big study to report. Warning that age has a negative impact on surgical outcomes.
Meta-Analysis and Meta-Regression Analysis of Outcomes of Carotid Endarterectomy and Stenting in the Elderly
JAMA Surg 2013 Dec 01;148(12)1140-1152, GA Antoniou, GS Georgiadis, EI Georgakarakos, SA Antoniou, N Bessias, JV Smyth, D Murray, MK Lazarides
A large meta-analysis (N = 44 studies) examined the risks of carotid endarterectomy (CEA; n = 512,685) and carotid stenting (n = 75,201) in the elderly (> 65 years) vs their younger counterparts.
The odds of the following were increased in the elderly:
Stroke with carotid stenting (2.4% vs 1.7%; OR = 1.56; 95% CI, 1.40–1.75)
Peri-interventional mortality with CEA (0.5% vs 0.4%; OR = 1.62; 95% CI, 1.47–1.77)
MI with CEA (OR = 1.64; 95% CI, 1.57–1.72) or carotid stenting (OR = 1.30; 95% CI, 1.16–1.45)
The authors concluded that “age should be considered when planning a carotid intervention,” given the increased risks of negative outcomes with either procedure in the elderly.
1 Expert Comment
Bruce A Perler MD, MBA
Uncertainty exists about the influence of advanced age on the outcomes of carotid revascularization.
To undertake a comprehensive review of the literature and conduct an analysis of the outcomes of carotid interventions in the elderly.
DESIGN AND SETTING
A systematic literature review was conducted to identify articles comparing early outcomes of carotid endarterectomy (CEA) or carotid stenting (CAS) in elderly and young patients.
MAIN OUTCOMES AND MEASURES
Combined overall effect sizes were calculated using fixed or random effects models. Meta-regression models were formed to explore potential heterogeneity as a result of changes in practice over time.
Our analysis comprised 44 studies reporting data on 512,685 CEA and 75,201 CAS procedures. Carotid stenting was associated with increased incidence of stroke in elderly patients compared with their young counterparts (odds ratio [OR], 1.56; 95% CI, 1.40-1.75), whereas CEA had equivalent cerebrovascular outcomes in old and young age groups (OR, 0.94; 95% CI, 0.88-0.99). Carotid stenting had similar peri-interventional mortality risks in old and young patients (OR, 0.86; 95% CI, 0.72-1.03), whereas CEA was associated with heightened mortality in elderly patients (OR, 1.62; 95% CI, 1.47-1.77). The incidence of myocardial infarction was increased in patients of advanced age in both CEA and CAS (OR, 1.64; 95% CI, 1.57-1.72 and OR, 1.30; 95% CI, 1.16-1.45, respectively). Meta-regression analyses revealed a significant effect of publication date on peri-interventional stroke (P = .003) and mortality (P < .001) in CAS.
CONCLUSIONS AND RELEVANCE
Age should be considered when planning a carotid intervention. Carotid stenting has an increased risk of adverse cerebrovascular events in elderly patients but mortality equivalent to younger patients. Carotid endarterectomy is associated with similar neurologic outcomes in elderly and young patients, at the expense of increased mortality.