Results of carotidal endarterectomy in different age group

Background. Carotid endarterectomy is an effective and safe operation aimed at treating patients with hemo-dynamically significant stenosis of the carotid arteries, the outcomes of which are well studied, and the permissible levels of postoperative complications are presented in the current recommendations. Nevertheless, the issues related to the incidence of cardiovascular accidents in different age groups of patients have not been sufficiently studied.

Objective. Analysis of hospital outcomes of carotid endarterectomy in different age groups. Design and methods. The study included 1416 patients who were operated on for stenotic lesions of the internal carotid arteries. According to the WHO classification, patients were divided into groups depending on age: up to 44 years — young age (n = 76); 45-59 years old — average age (n = 291); 60-74 — old age (n = 835); over 75 years old — old age (n = 214). The compensatory capabilities of cerebral blood flow were assessed by invasive measurement of the retrograde pressure in the internal carotid artery. The endpoints were death, myocardial infarction, acute cerebrovascular accident, transient ischemic attack, hemorrhagic complications, cranial nerve damage, combined endpoint.

Results. There were no significant differences in the incidence of all cardiovascular events. In the group of young patients, no lethal outcomes, myocardial infarction, acute cerebrovascular accident, or transient ischemic attack were recorded. All deaths were caused by the development of ischemic stroke as a result of distal embolization. In cases of non-fatal acute disorders of cerebral circulation, transient ischemic attacks in 1 patient of the 60-74 year group, the catastrophe developed against the background of thrombosis of the internal carotid arteries. In other 3 cases, on the background of the development of hyperperfusion syndrome. In 1 patient of the 60-74 year group, hemorrhagic transformation of the old ischemic focus with the development of intracerebral hematoma was recorded. There was also no significant intergroup difference in the incidence of hemorrhagic complications. The total number of all cardiovascular events in each group and the sample as a whole did not exceed one and a half percent, which corresponded to the standards described in the current recommendations.

Conclusion. There was no statistically significant difference in the development of adverse cardiovascular events depending on the patient’s age.

1. Kazantsev AN, Tarasov RS, Burkov NN, et al. Predictors of long-term complications after carotid endarterectomy. Khirurgiya. Zhurnal imeni N. I. Pirogova=Pirogov Russian Journal of Surgery. 2019;6: 2025. In Russian

2. Vinogradov RA, Matusevich VV Use of glomussparing techniques in surgery of carotid arteries. Angiologiya i sosudistaya hirurgiya=Angiology and vascular surgery. 2018;24(2): 201-205. In Russian

3. Kazantsev AN, Tarasov RS, Burkov NN, et al. Inhospital outcomes of transcutaneous coronary intervention and carotid endarterectomy in hybrid and staged regimens. Angiologiya i sosudistaya hirurgiya=Angiology and vascular surgery. 20i9;25(1): 101-107. In Russian

4. National guidelines for the management of patients with brachiocephalic artery disease. Angiologiya i sosudistaya hirurgiya=Angiology and vascular surgery. 2013;19(2): 4-68. In Russian

5. Chernyavsky MA, Gusev AA, Chernova DV, et al. Staged treatment of a multilevel lesions of brachiocephalic arteries in combination with coronary and valvular pathology of the heart. Angiologiya i sosudistaya hirurgiya=Angiology and vascular surgery. 2018;24(2): 165-171. In Russian

6. Korotkikh AV, Nekrasov DA, Medvedev VM, et al. Carotid endarterectomy in advanced age patients: effectiveness and safety. Kardiologiya i serdechno-sosudistaya khirurgiya=Cardiology and Cardiovascular Surgery. 2017;10(3): 57-61. In Russian

7. Nekrasov dA, Korotkikh AV, Plutakhin KA, et al. Carotid endarterectomy in elderly patients. Angiologiya i sosudistaya hirurgiya=Angiology and vascular surgery. 2016;22(S2): 259-260. In Russian

8. KazakovYuI, Pavlov EV, Federyakin DV, et al. Peculiarities of diagnosis and surgical policy in elderly patients with pathological tortuosity of the internal carotid artery. Angiologiya i sosudistaya hirurgiya=Angiology and vascular surgery. 2015;21(3): 112-117. In Russian

9. Gavrilenko AV, Kuklin AV, Kravchenko AA, et al. Efficiency of carotid endarterectomy in elderly and gerontic patients who suffered ischemic stroke. Annaly khirurgii=Annals of surgery. 2012; 1: 42-47. In Russian

10. Portnyagina EV, Sharistepanova SE, Portnyagin AF. Clinical and cost-effectiveness of carotid stenting and endarterectomy in different age groups. Klinicheskaya gerontologiya=Clinical Gerontology. 2014; 20 (7-8): 2531. In Russian

11. Kosenkov AN, Vinogradov RA, Vinokurov IA. Cerebral revascularization in patients older than 70 years. Kardiologiya i serdechno-sosudistaya khirurgiya=Cardiology and Cardiovascular Surgery. 2015;8(4): 9-11. In Russian

12. Narins CR, Illig KA. Patient selection for carotid stenting versus endarterectomy: a systematic review. J Vasc Surg. 2006;44(3): 661-672.

13. Roffi M, Mukherjee D, Clair DG. Carotid artery stenting vs. endarterectomy. Eur Heart. J. 2009; 30(22): 2693-2704.

14. Heo SH, Bushnell CD. Factors influencing decision making for carotid endarterectomy versus stenting in the very elderly. Front Neurol. 2017;8: 220.

15. Chiam PTL, Roubin GS, Iyer SS, et al. Carotid artery stenting in elderly patients: importance of case selection. Catheter. Cardiovasc Interv. 2008;72(3): 318324.

16. Antoniou GA, Georgiadis GS, Georgakarakos EI, et al. Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly. JAMA Surg. 2013;148(12): 1140-1152.

17. Bonati LH, Fraedrich G; Carotid Stenting Trialists’ Collaboration. Age modifies the relative risk of stenting versus endarterectomy for symptomatic carotid stenosis — a pooled analysis of EVA-3S, SpACE and ICSS. Eur J Vasc. Endovasc. Surg. 2011;41(2):153-158.

18. Rajamani K, Kennedy KF, Ruggiero NJ, et al. Outcomes of carotid endarterectomy in the elderly: report from the National Cardiovascular Data Registry. Stroke. 2013;44(4):1172-1174.