A new age-based analysis of the NCDR's Carotid Artery Revascularization and Endarterectomy (CARE) Registry®, published on Feb. 19 in Stroke, showed that the risk of death, stroke and perioperative complications following carotid endarterectomy (CEA) increases with age. The analysis also found that the majority of CEAs are performed in asymptomatic patients who have higher complication rates than symptomatic patients.
This retrospective analysis included 4,149 patients older than 70 years who underwent CEA, and found the primary outcome of stroke, death and myocardial infarction (MI) was observed in 2.9 percent of patients. The risk increased from 2.2 percent among those aged 70 to 74 years to 5.6 percent among those ≥85 years (p=0.003 for trend). One-third (33.1 percent) of patients were asymptomatic, and the primary endpoint was observed in 3.3 percent of symptomatic and 2.7 percent of asymptomatic patients. When patients were stratified according to age and the presence/absence of symptoms, there were non-statistically significant trends indicating increasing risk with increasing age. The adjusted odds ratio for the composite stroke/death/MI endpoint was 2.26 (95 percent CI 1.27-4.02) among patients older than 85 years compared with those aged 70 to 74 years, which achieved statistical significance.
The authors conclude that "CEA should be carefully weighted in asymptomatic patients, especially when they are older. Overall, the perioperative risk of complications after CEA in the elderly is within widely accepted guidelines," they add.
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