Clinical Outcomes after Carotid Endarterectomy in Patients with Contralateral Carotid Occlusion.

BACKGROUND: Severe carotid stenosis is typically treated with carotid endarterectomy (CEA), but there is debate about the safety of this procedure in patients with contralateral carotid occlusion (CCO). To compare 30-day outcomes after CEA in patients with severe carotid stenosis or without CCO. METHODS: This retrospective, single-institution analysis included 434 patients who underwent CEA. All CEAs were performed under general anesthesia, and carotid shunts were used in 32 patients. Patients were categorized into 2 groups according to patency of the contralateral carotid artery: groups I (no CCO, n = 394) and II (with CCO, n = 40). Demographics, preoperative symptomatic status, and frequency of early (<30 days) symptomatic neurologic complications and death were compared. RESULTS: Total mortality after CEA was 1.6% (n = 7), 7 and 0 in groups I and II, respectively (P = 0.39). Overall stroke rate was 3.5% (n = 15), 15 and 0 in groups I and II, respectively (P = 0.20). Rate of transient ischemic attacks was 1.4% (n = 6), 5 and 1 in groups I and II, respectively (P = 0.37). Symptomatic group I patients had a higher rate of stroke and/or death (6.7% vs. 0%) (P = 0.85). In asymptomatic patients, the stroke and/or death rate was higher in group II (3.4% vs. 8.3%, P < 0.05). In group II, the frequency of shunt placement was higher (3% vs. 53%, P = 0.001). At mean follow-ups of 75.4 ± 47.5 months (group I) and 72.7 ± 49.9 months (group II), 157 and 13 additional deaths had occurred in groups I and II, respectively (P = 0.21). CONCLUSIONS: Patients with CCO who undergo CEA do not appear to be at increased risk for perioperative incidence of stroke and/or death, or any neurologic event.

Resultados de la endarterectomía carotídea en pacientes ancianos / Results of carotid endarterectomy in elderly patients

Introducción. El 45% de los pacientes con ictus presenta una estenosis accesible quirúrgicamente. El objetivo de nuestro estudio es describir la respuesta a la endarterectomía (EA) carotídea en pacientes muy ancianos en relación con los más jóvenes. Material y método. Evaluación retrospectiva de la historia clínica de todos los pacientes intervenidos de endarterectomía en un hospital de tercer nivel entre enero de 1995 y diciembre de 2006. Los pacientes se agruparon en 75 años o más y los menores de esa edad. Se evaluó la incidencia de complicaciones perioperatorias en el primer mes de la cirugía y la mortalidad a largo plazo mediante un análisis de supervivencia. Resultados. Se recogieron datos de 147 EA en 134 pacientes de 75 o más años y 201 EA en 177 pacientes menores de 75 años. La incidencia de complicaciones perioperatorias fue similar en ambos grupos con una mortalidad del 2% en el grupo de mayor edad y una incidencia de ictus del 2,6% (la mitad, accidentes isquémicos transitorios). Los pacientes más ancianos tuvieron un seguimiento medio de 4,1 años con una supervivencia al año del 86% y a los 5 años del 54%, siendo la principal causa de muerte la cardiopatía. Conclusiones. La EA carotídea es una técnica segura y eficaz para el tratamiento de la estenosis carotídea extracraneal en los ancianos, presentando la misma morbimortalidad perioperatoria que en los jóvenes. La edad no debe modificar nuestra actitud terapéutica, aunque, en los ancianos debe realizarse un exhaustivo estudio cardiológico previo a la intervención(AU)

Introduction. Forty-five per cent of stoke patients have a surgically accessible stenosis. The objective of our study is to describe the response to carotid endarterectomy (EA) in patients of advanced age compared to younger ones. Material and method. Retrospective evaluation of the clinical history of all patients who underwent an endarterectomy in a tertiary hospital between January 1995 and December 2006. The patients were grouped into those 75years or older and those less than this age. The incidence of peri-operative complications in the first month after surgery, and the long-term mortality was evaluated using a survival analysis. Results. Data were collected on 147 EA in 134 patients of 75years or more, and on 201 EA in 177 patients less than 75 years-old. The incidence of peri-operative complications was similar in both groups, with a mortality of 2% in the older age group and a stroke incidence of 2.6% (half transient ischaemic accidents). The older patients had a mean follow-up of 4.1years, with a survival of 86% at one year and 54% at 5years and with the main cause of death being heart disease. Conclusions. Carotid EA is a safe and effective technique for the treatment of extracranial carotid stenosis in the elderly, having the same peri-operative morbidity and mortality as younger ones. Age must not affect our therapeutic attitude, although an exhaustive cardiology study must be made in the elderly prior to the operation(AU)

[Results of carotid endarterectomy in elderly patients]. / Resultados de la endarterectomía carotídea en pacientes ancianos.

INTRODUCTION: Forty-five per cent of stoke patients have a surgically accessible stenosis. The objective of our study is to describe the response to carotid endarterectomy (EA) in patients of advanced age compared to younger ones. MATERIAL AND METHOD: Retrospective evaluation of the clinical history of all patients who underwent an endarterectomy in a tertiary hospital between January 1995 and December 2006. The patients were grouped into those 75 years or older and those less than this age. The incidence of peri-operative complications in the first month after surgery, and the long-term mortality was evaluated using a survival analysis. RESULTS: Data were collected on 147 EA in 134 patients of 75 years or more, and on 201 EA in 177 patients less than 75 years-old. The incidence of peri-operative complications was similar in both groups, with a mortality of 2% in the older age group and a stroke incidence of 2.6% (half transient ischaemic accidents). The older patients had a mean follow-up of 4.1 years, with a survival of 86% at one year and 54% at 5 years and with the main cause of death being heart disease. CONCLUSIONS: Carotid EA is a safe and effective technique for the treatment of extracranial carotid stenosis in the elderly, having the same peri-operative morbidity and mortality as younger ones. Age must not affect our therapeutic attitude, although an exhaustive cardiology study must be made in the elderly prior to the operation.