Carotid endarterectomy in octogenarians and nonagenarians

Experience with carotid endarterectomy (CE) in patients 80 years of age and older is analyzed by reviewing results in terms of patient survival, quality of life and recurrence of symptoms of cerebral ischemia. During a 12 year period, 90 octogenarians underwent CE. Ages ranged from 80 to 93 years with a mean of 83 years. Two groups of patients younger than 80 years of age were selected from the series for comparison. There were no differences between age groups with respect to operative mortality and morbidity, with two deaths and one stroke in the elderly group. Follow-up periods ranged from one to 120 months with a mean of 39 months. There were two late strokes in patients older than 80 years of age. At late follow-up study, 87 per cent of patients operated upon for hemispheric symptoms were free of neurologic deficits; in contrast, only 67 per cent of those operated upon for nonhemispheric symptoms were symptom-free (p less than 0.05). The incidence of occlusive disease of the intracranial portion of the internal carotid artery was higher in the elderly group (p less than 0.01). The presence of intracranial occlusive disease represented an unfavorable factor in regard to the results of CE in patients with nonhemispheric symptoms. The over-all five year survival rate was 60 per cent. These data indicate that advanced age alone should not be considered a contraindication to CE. Excellent results should be expected in instances of operations performed for hemispheric symptoms. In instances of nonhemispheric symptoms, results are less encouraging because of the high incidence of intracranial carotid occlusive disease.