Study finds stroke-prevention surgery safe in growing 80-plus population

CHICAGO 11 oct 2008 – New research published in the October issue of Journal of the American College of Surgeons challenges the current opinion that patients in their eighties, who are often deemed "high-risk" due to their advanced age, should not undergo carotid endarterectomy – a stroke-preventing surgical procedure that clears blockages from the neck's carotid arteries.
Approximately 700,000 new and recurrent strokes occur annually in the United States, and it is estimated that 10 to 20 percent of them are related to carotid artery disease.
Several clinical trials have suggested that carotid endarterectomy can be used to safely and effectively prevent strokes in patients younger than 80 years of age. However, because of the perception that patients in their eighties and nineties are at increased risk, clinicians have recommended that these patients receive alternative treatments such as stenting.
"Age alone should not place patients in the high-risk category for carotid endarterectomy," said study authors Steven Katz, MD, FACS, and Amy Bremner, MD, of the Huntington Hospital, Pasadena, CA, and the Keck School of Medicine, Los Angeles, CA. "As the elderly population surges, it is crucial to identify strategies that can potentially limit the devastating consequences of stroke and its impact on the health care budget. Our study shows that carotid endarterectomy remains the treatment of choice in patients 80 years of age and older with substantial blockage of the carotid arteries."
The retrospective study, which analyzed the outcomes of 103 carotid endarterectomies in 95 patients between the ages of 80 and 94 years (59 men and 36 women; mean age = 83.7 years), showed a low incidence of neurologic complications, with only one transient ischemic attack (0.97 percent), two minor strokes (1.94 percent) and one major stroke (0.97 percent). There were no deaths within 30 days of operation. The combined stroke and death rate was 2.91 percent.
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The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 73,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.