For elderly, stroke risk up with carotid stenting; increased mortality with carotid endarterectomy
THURSDAY, Oct. 24 (HealthDay News) -- For patients undergoing a carotid intervention, age influences outcomes, according to a review published online Oct. 23 in JAMA Surgery.
George A. Antoniou, M.D., Ph.D., from the Hellenic Red Cross Hospital in Athens, Greece, and colleagues conducted a systematic literature review to examine the influence of advanced age on the outcomes of carotid revascularization. Forty-four studies were included, reporting data on 512,685 carotid endarterectomy (CEA) and 75,201 carotid stenting (CAS) procedures.
The researchers found that CAS correlated with increased incidence of stroke in elderly versus young patients (odds ratio, 1.56), while the cerebrovascular outcomes were equivalent for CEA in old and young age groups. Peri-interventional mortality risks were similar for CAS in old and young patients, but mortality was increased in elderly patients with CEA (odds ratio, 1.62). For both procedures, the incidence of myocardial infarction was increased for patients of advanced age (odds ratios, 1.64 for CAS and 1.30 for CEA). Publication date had a significant effect on peri-interventional stroke and mortality in CAS.
"It seems that CEA is associated with improved neurologic outcomes compared with CAS in elderly patients, at the expense of increased perioperative mortality, whereas both procedures are associated with increased risk of adverse cardiac events in advanced age," the authors write.
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