Carotid Endarterectomy in the Elderly Patient: Experience Over the Past 15 Years

The fastest growing population in the United States is greater than seventy-five years of age, and this is the population most prone to strokes. There has been some hesitation in performing carotid endarterectomy in the elderly. In this study, the authors attempted to evaluate short- and long-term effects of carotid endarterectomy in the elderly population and also compared these with those in younger patients. Results of 74 carotid endarterectomies in 68 patients more than seventy-five years of age performed by a single surgeon at Robert Packer Hospital/Guthrie Clinic in rural Pennsylvania over the past fifteen years were evaluated. These were compared with a similar number of surgeries done in younger patients by the same surgeon over the same time period. They found a 4% perioperative stroke rate and 4% perioperative mortality in the elderly patients compared with 4% perioperative stroke rate and 2.7% perioperative mortality in younger patients. Life table analysis done for elderly patients revealed a cumulative survival of 76.9% and a stroke-free survival of 70% at ten years. They found carotid endarterectomy as well tolerated in the elderly population as in the younger patients. The long-term benefits of carotid endarterectomy in the elderly in their setting have been excellent, and there is much to recommend this surgery in elderly patients with carotid artery stenosis.