Document Detail


Safety and efficacy of carotid stenting in the very elderly.
MedLine Citation:
PMID:  20088017     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA) in patients at high risk for complications from surgery. The very elderly (>or=80-year-old) are one subgroup of patients identified as being at increased risk for carotid surgery. However, there is concern that the very elderly are also at increased risk for complications of CAS. A stroke and death rate of 12% was reported in very elderly patients during the roll-in phase of Carotid Revascularization Endarterectomy versus Stent Trial (CREST). We are reporting on a large clinical series of CAS with independent neurological assessment in the very elderly. METHODS: Between 1994 and 2008, a consecutive series of 418 CAS patients (>or=80-year-old) were treated at four high-volume centers with extensive CAS experience. Independent neurologic assessment was performed after CAS procedures. Thirty-day follow-up information was available in 389 patients. RESULTS: The average age was 83.2 +/- 2.8 years. Most patients were male (63.2%), and the target lesion carotid stenosis was asymptomatic in two-thirds (68.2%) of patients. The majority of patients treated with CAS had a history of coronary artery disease (74.4%), hypertension (87.8%), and dyslipidemia (71.1%). One third (30.1%) were diabetic and more than half (56.5%) were current or former smokers. Embolic protection devices (EPD) were used in 78.7% of cases with the CAS procedure being performed before EPD availability being the most common reason for not using them. The overall 30-day incidence of stroke and death was 2.8% (11/389). The cumulative incidence of major cardiovascular events (stroke, death, or myocardial infarction) during that time period was 3.3% (13/389). CONCLUSIONS: This large series of CAS with independent neurologic assessment is convincing evidence that the very elderly (>or=80 years) can safely undergo CAS with stroke and death rates comparable to younger patients. The key to obtaining these excellent results is that CAS be performed by high volume, experienced operators who exercise restraint regarding patient selection.
Authors:
Arthur Grant; Christopher White; Gary Ansel; Michael Bacharach; Christopher Metzger; Carlos Velez
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  75     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-30     Completed Date:  2010-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  651-5     Citation Subset:  IM    
Copyright Information:
(c) 2009 Wiley-Liss, Inc.
Affiliation:
Cardiology Associates, Mobile, Alabama, USA. chipgrantmd@me.com
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged, 80 and over
Angioplasty / adverse effects,  instrumentation*,  mortality
Carotid Stenosis / mortality,  therapy*
Clinical Competence
Endarterectomy, Carotid / adverse effects
Female
Hospital Mortality
Humans
Male
Myocardial Infarction / etiology
Neurologic Examination
Patient Selection
Retrospective Studies
Risk Assessment
Risk Factors
Stents*
Stroke / etiology
Time Factors
Treatment Outcome
United States / epidemiology
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2010 Apr 1;75(5):658   [PMID:  20333672 ]
Catheter Cardiovasc Interv. 2010 Apr 1;75(5):656-7   [PMID:  20333671 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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