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Outcomes after Carotid Angioplasty and Stenting in Symptomatic Octogenarians

  • M. A. Almekhlafi (a1) (a2) (a3), P. L. Couillard (a1), A. Pandya (a1), N. Shobha (a1), W. F. Morrish (a4), J. H. Wong (a1) and M. D. Hill (a1) (a2) (a4) (a5)...

Abstract

Objective:

Octogenarians were excluded from participation in many carotid endarterectomy trials due to the high complication rates observed in past studies. However, stroke resulting from carotid stenosis is expected to increase with the aging population. Moreover, advances in Carotid Angioplasty and Stenting (CAS) techniques have resulted in perceived improved safety of this procedure. We sought to review our experience with carotid stenting in symptomatic octogenarians with an emphasis on short-term outcomes and complications.

Methods:

This is a retrospective longitudinal cohort study of all symptomatic patients who underwent CAS in our center between 1997 and 2007. Thirty-day stroke and death rates, and length of hospitalization were compared between the symptomatic octogenarians and non-octogenarians.

Results:

A total of 214 procedures were performed on 211 symptomatic patients (56 females). Fifty-nine patients (14 females) were octogenarians. The median (interquartile range) age on procedure date for the octogenarian cohort was 83 (4) years. Periprocedural death occurred in two (3.4%) octogenarians and five (3.3%) non-octogenarians (p = 0.97). At 30 days from the procedure, stroke occurred in four (6.8%) octogenarians and seven (4.6%) non-octogenarians (p= 0.52). The mean hospital stay (4.8 days) was not different between the two cohorts. Age was not a predictor of the 30-day risk of composite stroke or death.

Conclusion:

The complications rate observed in octogenarians was not significantly higher than non-octogenarians. Our findings suggest that octogenarians should be included in randomized trials examining CAS to better define the risk-benefit profile of this procedure in the elderly.

Résumé: Objectif:

Les octogénaires ont été exclus de plusieurs essais cliniques portant sur l’endartérectomie carotidienne à cause du taux élevé de complications observé dans les études antérieures. Cependant, avec le vieillissement de la population, il est à prévoir que l’accident vasculaire cérébral dû à une sténose carotidienne sera de plus en plus fréquent. De plus, cette intervention est perçue comme étant plus sûre à cause des progrès au niveau des techniques d’angioplastie carotidienne et de mise en place d’une endoprothèse (ACEP). Nous avons révisé notre expérience concernant la mise en place d’une endoprothèse carotidienne chez des octogénaires symptomatiques en mettant l’emphase sur les résultats à court terme et les complications.

Méthode:

Il s’agit d’une étude longitudinale rétrospective portant sur une cohorte constituée de tous les patients symptomatiques qui ont subi une ACEP dans notre centre entre 1997 et 2007. Nous avons comparé les taux d’accident vasculaire cérébral, les taux de décès et la durée d’hospitalisation entre les octogénaires symptomatiques et les non-octogénaires.

Résultats:

Au total, 214 interventions ont été effectuées chez 211 patients symptomatiques, dont 56 femmes. Cinquante-neuf de ces patients étaient des octogénaires, dont 14 femmes. L’âge médian (écart interquartile) au moment de l’intervention était de 83 (4) ans pour la cohorte d’octogénaires. Deux (3,4%) octogénaires et 5 (3,3%) non-octogénaires (p = 0,97) sont décédés dans la période périopératoire. Quatre octogénaires (6,8%) et 7 non-octogénaires (4,6%) ont subi un AVC (p = 0,52) au cours des 30 jours suivant l’intervention. La durée moyenne d’hospitalisation (4,8 jours) était la même dans les deux cohortes. L’âge ne prédisait pas le risque combiné d’AVC ou de décès dans les 30 jours suivant l‘intervention.

Conclusion:

Le taux de complication observé chez les octogénaires n’était pas significativement plus élevé que celui observé chez les non-octogénaires. Selon nos observations, les octogénaires devraient être inclus dans les essais randomisés portant sur l’ACEP pour mieux définir le profil de risque et de bénéfice de cette intervention chez les patients âgés.

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Copyright

Corresponding author

Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada

References

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