%0 Journal Article
%T Periprocedural Outcomes of Carotid Artery Stenting in Elderly Patients - Journal of Vascular Surgery
%A H. Yamamoto
%A M. Nanto
%A M. Takado
%A S. Tanigawa
%A T. Ogawa
%A Y. Goto
%A Y.J. Nakahara
%J Journal of Vascular Surgery Home Page
%D 2018
%R https://doi.org/10.1016/j.jvs.2018.05.023
%X Retrospective analysis of a single-center experience. ¡°Specialized neuroendovascular physicians¡± performed carotid artery stenting (CAS) in 86 symptomatic and 40 asymptomatic patients of whom 36 were elderly (>80 years old) and 90 were nonelderly (<80 years old). The elderly and nonelderly groups were well-matched in terms of risk factors except for dyslipidemia. In symptomatic patients, CAS was performed more than 3 weeks after symptom onset. All patients received statins at least 2 weeks before CAS and dual antiplatelet therapy at least 1 week before CAS. Embolic protection devices were used in all cases. Although the incidence of major stroke was approximately the same in the elderly vs nonelderly group (2.8% vs 3.3%; P = 1.0), the incidence of minor stroke was significantly higher in patients over 80 years old (8.3% vs 0%; P = .02). The authors concluded that CAS can be performed safely in patients over 80 years old. Risk of stroke associated with CAS has been shown in many studies to be higher in patients more than 80 years old because of greater arterial tortuosity, increased aortic arch complexity, and more calcifications. One would expect favorable results of CAS in this series because symptomatic patients were not treated until more than three weeks after symptom onset. Currently carotid endarterectomy or CAS is recommended within a few days of minor strokes or transient ischemic attacks to gain the most benefit of the interventions even though the periprocedural risk has been shown to be higher when either intervention is performed soon after onset of symptoms. The authors of this report concluded that CAS can be performed ¡°safely¡± in patients more than 80 years old, even though the combined major and minor stroke rate was 11.1%! They made this claim because the incidence of stroke in the elderly vs nonelderly patients did not reach statistical significance (P = .095). However, the risk of any stroke was actually more than three times higher (11.1% vs 3.3%) in elderly patients compared to nonelderly patients. This study adds further evidence to a multitude of publications documenting the increased risk of CAS in patients more than 80 years old. It's time for CAS enthusiasts to stop emphasizing the ¡°safety¡± of this intervention that has been proven time and time again to be ill-advised in many of these elderly patients.
%U https://www.jvascsurg.org/article/S0741-5214(18)31097-8/fulltext