Carotid artery stenting in octogenarians: Is it too risky?

Recent clinical trials have shown that the safety of carotid angioplasty and stenting (CAS) is equivalent to that of carotid endarterectomy (CEA) in high-risk patients. Despite this, the beneficial outcome in octogenarians has come under scrutiny in light of the interim results of the Carotid Artery Revascularization versus Stent Trial (CREST). We report on a single-center experience of patients ≥80 years of age compared to younger cohorts treated with CAS. CAS procedures, performed exclusively by vascular surgeons, from April 2001 to December 2004 were retrospectively reviewed. Mechanical cerebral protection with either a distal balloon occlusion system or a distal filter device was used in 140 cases and in all patients ≥80 years of age. Patients were divided into age categories: <60, 60-69, 70-79, and ≥80 years old. Data analysis included patient demographics, perioperative death, myocardial infarction, stroke, and other major complications. Statistics were derived using the SPSS program. A total of 158 procedures were performed on 151 patients. There were no statistical differences among the four groups with respect to mean stenosis or the presence of preoperative symptoms. Rates of stroke were 1 of 16 (6.25%) <60 years old, 0 of 54 (0%) age 60-69, 2 of 59 (3.4%) age 70-79, and 1 of 29 (3.4%) ≥80 years old. Preoperative symptoms were present in 6 of 29 (21%) patients ≥80 years old. Myocardial infarction and mortality rates were 0% for all groups. There were no statistical differences in stroke, death, or nonneurological complication rates among the four groups. Vascular surgeons facile at CAS should expect 30-day results comparable to CEA in all age groups. Octogenarians, whether symptomatic or asymptomatic, should not be denied this form of treatment.