Skip to main content
Erschienen in: European Surgery 1/2020

16.04.2019 | original article

Evaluation and comparison of postoperative outcomes of octogenarians and non-octogenarians undergoing carotid endarterectomy

verfasst von: Serkan Burç Deşer, MD, Mustafa Kemal Demirag, MD, Fersat Kolbakir, MD, Semih Murat Yucel, MD, Murat Muzaffer Güçlü, MD, Merve Polat, MD, Hasan Tahsin Keceligil, MD

Erschienen in: European Surgery | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Summary

Introduction

The aim of this study was to compare and evaluate the postoperative outcomes of carotid endarterectomy (CEA) in symptomatic and asymptomatic octogenarians and younger patients in a single institution, if octogenarians are eligible for CEA.

Methods

A total of 190 patients (149 males, 41 females; mean age 69.59 ± 9.87 years; range 47 to 92 years) who underwent eversion or conventional CEA with patchplasty, under general or local anesthesia, were included in this study.

Results

No statistically significant difference was found in terms of postoperative death (p = 1), postoperative stroke (p = 0.592), and postoperative bleeding (p = 0.659), while blood creatinine level was significantly higher in octogenarians. Postoperative stroke and death were seen in none of the octogenarians, although 4 postoperative deaths and 6 major strokes were seen among non-octogenarians. No difference was found in females (octogenarians vs. non-octogenarians) in terms of death (p = 1.00) and stroke (p = 1.00) and no difference was found in males (octogenarians vs. non-octogenarians) in terms of death (p = 1.00) and stroke (p = 1.00).

Conclusion

We thought that CEA remains the most efficient treatment modality among symptomatic and asymptomatic octogenarians with severe carotid artery stenosis and no difference was found compared to non-octogenarians. Advanced age should not be considered as a high-risk group and selected octogenarians are good candidates for CEA.
Literatur
1.
Zurück zum Zitat Miller MT, Comerota AJ, Tzilinis A, Daoud Y, Hammerling J. Carotid endarterectomy in octogenarians: Does increased age indicate “high risk?”. J Vasc Surg. 2005;41:231–7.CrossRef Miller MT, Comerota AJ, Tzilinis A, Daoud Y, Hammerling J. Carotid endarterectomy in octogenarians: Does increased age indicate “high risk?”. J Vasc Surg. 2005;41:231–7.CrossRef
2.
Zurück zum Zitat Hobson RW, Howard VJ, Roubin GS, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40(6):1106–11.CrossRef Hobson RW, Howard VJ, Roubin GS, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40(6):1106–11.CrossRef
3.
Zurück zum Zitat Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325:445–53.CrossRef Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325:445–53.CrossRef
4.
Zurück zum Zitat Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A. Editor’s choice e management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55:3–81.CrossRef Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A. Editor’s choice e management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55:3–81.CrossRef
5.
Zurück zum Zitat Rajamani K, Kennedy KF, Ruggiero NJ, Rosenfield K, Spertus J, Chaturvedi S. Outcomes of carotid endarterectomy in the elderly. Report from the National Cardiovascular Registry. Stroke. 2013;44:1172–4.CrossRef Rajamani K, Kennedy KF, Ruggiero NJ, Rosenfield K, Spertus J, Chaturvedi S. Outcomes of carotid endarterectomy in the elderly. Report from the National Cardiovascular Registry. Stroke. 2013;44:1172–4.CrossRef
6.
Zurück zum Zitat Manolio TA, Kronmal RA, Burke GL, et al. Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke. 1996;27:1479–86.CrossRef Manolio TA, Kronmal RA, Burke GL, et al. Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke. 1996;27:1479–86.CrossRef
7.
Zurück zum Zitat Schneider JR, Droste JS, Schindler N, Golan JF. Carotid endarterectomy in octogenarians: comparison with patient characteristics and outcomes in younger patients. J Vasc Surg. 2000;31(5):927–35.CrossRef Schneider JR, Droste JS, Schindler N, Golan JF. Carotid endarterectomy in octogenarians: comparison with patient characteristics and outcomes in younger patients. J Vasc Surg. 2000;31(5):927–35.CrossRef
8.
Zurück zum Zitat Marini C, Baldassarre M, Russo T, et al. Burden of first-ever ischemic stroke in the oldest old. Evidence from a population-based study. Baillieres Clin Neurol. 2004;62:77–81. Marini C, Baldassarre M, Russo T, et al. Burden of first-ever ischemic stroke in the oldest old. Evidence from a population-based study. Baillieres Clin Neurol. 2004;62:77–81.
9.
Zurück zum Zitat Kammersgaard LP, Jorgensen HS, Reith J, et al. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing. 2004;33:149–54.CrossRef Kammersgaard LP, Jorgensen HS, Reith J, et al. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing. 2004;33:149–54.CrossRef
10.
Zurück zum Zitat van Reichmann BL, van Lammeren GW, Moll FL, de Borst GJ. Is Age of 80 years a threshold for carotid revascularization? Curr Cardiol Rev. 2011;7:15–21.CrossRef van Reichmann BL, van Lammeren GW, Moll FL, de Borst GJ. Is Age of 80 years a threshold for carotid revascularization? Curr Cardiol Rev. 2011;7:15–21.CrossRef
11.
Zurück zum Zitat Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Executive committee for the asymptomatic carotid atherosclerosis study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–8.CrossRef Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Executive committee for the asymptomatic carotid atherosclerosis study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–8.CrossRef
12.
Zurück zum Zitat MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet. 2004;363:1491–502.CrossRef MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet. 2004;363:1491–502.CrossRef
13.
Zurück zum Zitat Aichner FT, Topakian R, Alberts MJ, Bhatt DL, Haring HP, Hill MD, REACH Registry Investigators. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry. Eur J Neurol. 2009;16:902–8.CrossRef Aichner FT, Topakian R, Alberts MJ, Bhatt DL, Haring HP, Hill MD, REACH Registry Investigators. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry. Eur J Neurol. 2009;16:902–8.CrossRef
14.
Zurück zum Zitat Luebke T, Brunkwall J. Development of a Microsimulation model to predict stroke and long-term mortality in adherent and nonadherent medically managed and surgically treated octogenarians with asymptomatic significant carotid artery stenosis. World Neurosurg. 2016;92:513–20.CrossRef Luebke T, Brunkwall J. Development of a Microsimulation model to predict stroke and long-term mortality in adherent and nonadherent medically managed and surgically treated octogenarians with asymptomatic significant carotid artery stenosis. World Neurosurg. 2016;92:513–20.CrossRef
15.
Zurück zum Zitat Ballotta E, Toniato A, Da Roit A, Lorenzetti R, Piatto G, Baracchini C. Carotid endarterectomy for asymptomatic carotid stenosis in the very elderly. J Vasc Surg. 2015;61:382–8.CrossRef Ballotta E, Toniato A, Da Roit A, Lorenzetti R, Piatto G, Baracchini C. Carotid endarterectomy for asymptomatic carotid stenosis in the very elderly. J Vasc Surg. 2015;61:382–8.CrossRef
16.
Zurück zum Zitat Fantozzi C, Taurino M, Rizzo L, Stella N, Persiani F. Carotid Endarterectomy or stenting in octogenarians in a monocentric experience. Ann Vasc Surg. 2016;33:132–7.CrossRef Fantozzi C, Taurino M, Rizzo L, Stella N, Persiani F. Carotid Endarterectomy or stenting in octogenarians in a monocentric experience. Ann Vasc Surg. 2016;33:132–7.CrossRef
17.
Zurück zum Zitat Okawa M, Ogata T, Abe H, Fukuda K, Higashi T, Inoue T. Do octogenarians still have a high risk of adverse outcomes after carotid endarterectomy in the era of a super-aged society? A single-center study in Japan. J Stroke Cerebrovasc Dis. 2015;24:370–3.CrossRef Okawa M, Ogata T, Abe H, Fukuda K, Higashi T, Inoue T. Do octogenarians still have a high risk of adverse outcomes after carotid endarterectomy in the era of a super-aged society? A single-center study in Japan. J Stroke Cerebrovasc Dis. 2015;24:370–3.CrossRef
18.
Zurück zum Zitat Pol RA, Reijnen MM, Lont M, Tielliu IF, van Sterkenburg SM, van den Dungen JJ, Zeebregts CJ. Safety and efficacy of carotid endarterectomy in octogenarians. Ann Vasc Surg. 2013;27(6):736–42.CrossRef Pol RA, Reijnen MM, Lont M, Tielliu IF, van Sterkenburg SM, van den Dungen JJ, Zeebregts CJ. Safety and efficacy of carotid endarterectomy in octogenarians. Ann Vasc Surg. 2013;27(6):736–42.CrossRef
19.
Zurück zum Zitat Almekhlafi MA, Couillard PL, Pandya A, Shobha N, Morrish WF, Wong JHH. Outcomes after carotid angioplasty and stenting in symptomatic octogenarians. Can J Neurol Sci. 2011;38(3):446–51. May.CrossRef Almekhlafi MA, Couillard PL, Pandya A, Shobha N, Morrish WF, Wong JHH. Outcomes after carotid angioplasty and stenting in symptomatic octogenarians. Can J Neurol Sci. 2011;38(3):446–51. May.CrossRef
20.
Zurück zum Zitat Norman PE, Semmens JB, Laurvick CL, Lawrence-Brown M. Long-term relative survival in elderly patients after carotid endarterectomy: a population-based study. Stroke. 2003;34(7):e95–8.CrossRef Norman PE, Semmens JB, Laurvick CL, Lawrence-Brown M. Long-term relative survival in elderly patients after carotid endarterectomy: a population-based study. Stroke. 2003;34(7):e95–8.CrossRef
21.
Zurück zum Zitat Kueh SH, Livingstone V, Thomson IA. Carotid endarterectomy in octogenarians. N Z Med J. 2012;125(1364):77–82.PubMed Kueh SH, Livingstone V, Thomson IA. Carotid endarterectomy in octogenarians. N Z Med J. 2012;125(1364):77–82.PubMed
22.
Zurück zum Zitat Davies KJ, Thapar A, Kasivisvanathan V, Shalhoub J, Davies AH. Review of trans-Atlantic cardiovascular best medical therapy guidelinesdrecommendations for asymptomatic carotid atherosclerosis. Curr Vasc Pharmacol. 2013;11:514–23.CrossRef Davies KJ, Thapar A, Kasivisvanathan V, Shalhoub J, Davies AH. Review of trans-Atlantic cardiovascular best medical therapy guidelinesdrecommendations for asymptomatic carotid atherosclerosis. Curr Vasc Pharmacol. 2013;11:514–23.CrossRef
23.
Zurück zum Zitat Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004;363(9413):915–24.CrossRef Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004;363(9413):915–24.CrossRef
24.
Zurück zum Zitat Chaturvedi S, Matsumura JS, Gray W, et al. Carotid artery stenting in octogenarians: periprocedural stroke risk predictor analysis from the multicenter Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) clinical trial. Stroke. 2010;41:757–64.CrossRef Chaturvedi S, Matsumura JS, Gray W, et al. Carotid artery stenting in octogenarians: periprocedural stroke risk predictor analysis from the multicenter Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) clinical trial. Stroke. 2010;41:757–64.CrossRef
25.
Zurück zum Zitat Usman AA, Tang GL, Eskandari MK. Metaanalysis of procedural stroke and death among octogenarians: carotid stenting versus carotid endarterectomy. J Am Coll Surg. 2009;208(6):1124–31.CrossRef Usman AA, Tang GL, Eskandari MK. Metaanalysis of procedural stroke and death among octogenarians: carotid stenting versus carotid endarterectomy. J Am Coll Surg. 2009;208(6):1124–31.CrossRef
26.
Zurück zum Zitat Mantese VA, Timaran CH, Chiu D, al Investigators C. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010;41:S31–S4.CrossRef Mantese VA, Timaran CH, Chiu D, al Investigators C. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010;41:S31–S4.CrossRef
Metadaten
Titel
Evaluation and comparison of postoperative outcomes of octogenarians and non-octogenarians undergoing carotid endarterectomy
verfasst von
Serkan Burç Deşer, MD
Mustafa Kemal Demirag, MD
Fersat Kolbakir, MD
Semih Murat Yucel, MD
Murat Muzaffer Güçlü, MD
Merve Polat, MD
Hasan Tahsin Keceligil, MD
Publikationsdatum
16.04.2019
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 1/2020
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-019-0584-y

Weitere Artikel der Ausgabe 1/2020

European Surgery 1/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.