Even though it might be intuitively considered a suitable treatment for the elderly patient at high surgical risk, early reports demonstrate increased incidence of cerebrovascular complications in this group of patients. 22Īngioplasty and stenting has emerged as an alternative, less invasive therapeutic method of treating carotid disease. 4 - 42 Yet, it is this age group of patients who have significant risks of stroke and would potentially benefit from carotid intervention. In total, 39 observational studies have reported controversial results of CEA in elderly patients. 1 - 3 Patients older than 80 years were excluded from these landmark trials therefore, uncertainty exists regarding the influence of advanced age on the outcomes of carotid revascularization. The effectiveness of carotid endarterectomy (CEA) in stroke prevention in patients with symptomatic or asymptomatic extracranial carotid disease has been established in randomized controlled trials. Carotid endarterectomy is associated with similar neurologic outcomes in elderly and young patients, at the expense of increased mortality. Carotid stenting has an increased risk of adverse cerebrovascular events in elderly patients but mortality equivalent to younger patients. Meta-regression analyses revealed a significant effect of publication date on peri-interventional stroke ( P = .003) and mortality ( P < .001) in CAS.Ĭonclusions and Relevance Age should be considered when planning a carotid intervention. 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). 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). Carotid stenting was associated with increased incidence of stroke in elderly patients compared with their young counterparts (odds ratio, 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). Results Our analysis comprised 44 studies reporting data on 512 685 CEA and 75 201 CAS procedures. Meta-regression models were formed to explore potential heterogeneity as a result of changes in practice over time.
Main Outcomes and Measures Combined overall effect sizes were calculated using fixed or random effects models. Objective To undertake a comprehensive review of the literature and conduct an analysis of the outcomes of carotid interventions in the elderly.ĭesign 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. Importance Uncertainty exists about the influence of advanced age on the outcomes of carotid revascularization.
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