Stroke Prevention Surgery Safe for 90-year-olds

NEW YORK (Reuters Health) - Carotid endarterectomy (CEA), a type of surgery that may help prevent strokes, can be safely performed in elderly individuals, new research suggests. Ideally, however, the operation should be limited to patients who are medically fit and are experiencing symptoms from a narrowed carotid artery.

The carotid arteries, which lie on each side of the neck, are the major vessels that supply blood to the brain. Strokes can occur when plaques that have formed in the carotids break off or otherwise obstruct blood flow to the brain. CEA involves making a small incision in the affected artery and inserting an instrument to remove the plaque.

Evidence from two major trials, one in North America and one in Europe, has suggested that older patients derive a greater benefit from CEA than younger ones. However, neither trial included patients in their 90s.

In the present study, reported in the Archives of Surgery, Dr. Quentin J. Durward and colleagues, from the Center for Neurosciences, Orthopaedics & Spine, PC in Dakota Dunes, South Dakota, describe the outcomes of 26 patients, 89 years of age and older, who underwent CEA at their center since 1995.

Except for three patients, all of the subjects had symptoms of low blood flow to the brain. Four patients had plaque build-up in both carotid arteries and, therefore, underwent two CEAs each.

Despite their advanced age, none of the subjects experienced brain or heart complications during or after surgery, the authors note. On average, patients were hospitalized for 2 days. One patient developed vocal cord paralysis, but it resolved over time.

After two years, four patients had died from non-stroke-related causes and the remainder were alive.

"We believe CEA should be considered in nonagenarian patients" with severe carotid narrowing that causes symptoms, the authors conclude, provided the patients are otherwise well medically. "Our recommendations are less certain" in cases in which there's narrowing, but no symptoms, the team says.

SOURCE: Archives of Surgery, July 2005.