Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-23T12:12:01.369Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcomes after Carotid Angioplasty and Stenting in Symptomatic Octogenarians

Published online by Cambridge University Press:  02 December 2014

M. A. Almekhlafi ,
P. L. Couillard ,
A. Pandya ,
N. Shobha ,
W. F. Morrish ,
J. H. Wong  and
M. D. Hill
M. A. Almekhlafi*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Internal Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
P. L. Couillard
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
A. Pandya
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
N. Shobha
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
W. F. Morrish
Affiliation:
Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
J. H. Wong
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
M. D. Hill
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada Department of Medicine, University of Calgary, Calgary, Alberta, Canada
*
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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:

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.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 446 - 451
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1 Fairhead, JF, Rothwell, PM. The need for urgency in identification and treatment of symptomatic carotid stenosis is already established. Cerebrovasc Dis. 2005;19(6):355–8.Google Scholar
2 Inzitari, D, Eliasziw, M, Gates, P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 2000 Jun 8;342(23):1693–700.Google Scholar
3 Halliday, A, Mansfield, A, Marro, J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004 May 8;363(9420):1491–502.Google Scholar
4 Ringleb, PA, Allenberg, J, Bruckmann, H, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised noninferiority trial. Lancet. 2006 Oct 7;368(9543):1239–47.Google Scholar
5 Navin, DM, Sacco, WJ. Science and evidence-based considerations for fulfilling the SALT triage framework. Disaster Med Public Health Prep. 2010 Mar;4(1):10–12; author reply 12.CrossRefGoogle ScholarPubMed
6 Gurm, HS, Yadav, JS, Fayad, P, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008 Apr 10;358(15):1572–9.Google Scholar
7 Gussoni, G, Campanini, M, Silingardi, M, et al. In-hospital symptomatic venous thromboembolism and antithrombotic prophylaxis in internal medicine. Findings from a multicenter, prospective study. Thromb Haemost. 2009 May;101(5):893–901.Google Scholar
8 Gelabert, HA, Moore, WS. Carotid endarterectomy without angiography. Surg Clin North Am. 1990 Feb;70(1):213–23.CrossRefGoogle ScholarPubMed
9 Ramirez-Lassepas, M. Stroke and the aging of the brain and the arteries. Geriatrics. 1998 Sep;53 Suppl 1:S44–8.Google ScholarPubMed
10 Endarterectomy for asymptomatic carotid artery stenosis. Executive committee for the asymptomatic carotid atherosclerosis study. JAMA. 1995 May 10;273(18):1421–8.Google Scholar
11 Hobson, RW 2nd, Howard, VJ, Roubin, GS, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST leadin phase. J Vasc Surg. 2004 Dec;40(6):1106–11.Google Scholar
12 Shobha, N, Almekhlafi, MA, Pandya, A, et al. Carotid stenting in asymptomatic carotid stenosis: the Calgary experience. Can J Neurol Sci. 2010;37(5):568–73.Google Scholar
13 Hill, MD, Morrish, W, Soulez, G, et al. Multicenter evaluation of a self-expanding carotid stent system with distal protection in the treatment of carotid stenosis. AJNR Am J Neuroradiol. 2006 Apr;27(4):759–65.Google Scholar
14 Tang, TY, Howarth, SP, Miller, SR, et al. Correlation of carotid atheromatous plaque inflammation using USPIO-enhanced MR imaging with degree of luminal stenosis. Stroke. 2008 Jul;39(7): 2144–7.Google Scholar
15 Shawl, F, Kadro, W, Domanski, MJ, et al. Safety and efficacy of elective carotid artery stenting in high-risk patients. J Am Coll Cardiol. 2000 Jun;35(7):1721–8.Google Scholar
16 Stanziale, SF, Marone, LK, Boules, TN, et al. Carotid artery stenting in octogenarians is associated with increased adverse outcomes. J Vasc Surg. 2006 Feb;43(2):297–304.Google Scholar
17 Lam, RC, Lin, SC, DeRubertis, B, Hynecek, R, Kent, KC, Faries, PL. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg. 2007 May;45(5): 875–80.Google Scholar
18 Linfante, I, Andreone, V, Akkawi, N, Wakhloo, AK. Internal carotid artery stenting in patients over 80 years of age: single-center experience and review of the literature. J Neuroimaging. 2009 Apr;19(2):158–63. Epub 2008 Sep 17.CrossRefGoogle ScholarPubMed
19 Chastain, HD 2nd, Gomez, CR, Iyer, S, et al. Influence of age upon complications of carotid artery stenting. UAB neurovascular angioplasty team. J Endovasc Surg. 1999 Aug;6(3):217–22.Google Scholar
20 Villalobos, HJ, Harrigan, MR, Lau, T, et al. Advancements in carotid stenting leading to reductions in perioperative morbidity among patients 80 years and older. Neurosurgery. 2006 Feb;58(2):233–40; discussion 233-40.Google Scholar
21 Setacci, C, de Donato, G, Chisci, E, et al. Is carotid artery stenting in octogenarians really dangerous? J Endovasc Ther. 2006 Jun;13 (3):302–9.Google Scholar
22 Grant, A, White, C, Ansel, G, Bacharach, M, Metzger, C, Velez, C. Safety and efficacy of carotid stenting in the very elderly. Catheter Cardiovasc Interv. 2010 Apr 1;75(5):651–5.Google Scholar
23 Zahn, R, Ischinger, T, Hochadel, M, et al. Carotid artery stenting in octogenarians: results from the ALKK carotid artery stent (CAS) Registry. Eur Heart J. 2007 Feb;28(3):370–5.Google Scholar