Rosenthal D, Rudderman R H, Jones D H, Clark M D, Stanton P E, Lamis P A, Daniels W W
J Vasc Surg. 1986 May;3(5):782-7. doi: 10.1067/mva.1986.avs0030782.
To evaluate the role of carotid endarterectomy (CE) in patients 80 years and older an 8-year study of 172 nonrandomized cases of octogenarians with cerebrovascular disease was done. Ninety octogenarians underwent CE whereas 82 octogenarians, with arteriographically established carotid artery disease, were not operated on and served as a control series. The stroke rate after CE was 6%. In follow-up extending to 8 years the late stroke rate was only 2%, whereas the cumulative long-term stroke rate in the nonoperated group was 16%. These late strokes were appropriate to the side of the arteriographically demonstrated disease. In 1008 nonoctogenarians who underwent CE during this same time interval, the stroke rate after CE was 2% and the mortality rate was 0.6%. In the octogenarian population, however, the mortality rate after stroke was an alarming 40% in the operated group and 62% in the nonoperated control group. Arteriographic flow-limiting (greater than 75% stenosis) intracranial occlusive disease was identified in 53% of the octogenarians undergoing operation and in all patients who suffered a postoperative neurologic deficit. This incidence of severe intracranial disease was nearly five times that of the nonoctogenarian patients undergoing CE. Although the stroke rate after CE in the octogenarian patient was 6%, the late stroke rate was only 2% compared with the cumulative stroke rate of 16% in the nonoperated octogenarian patients. Severe intracranial occlusive disease and, therefore, flow deprivation may play a more significant role as a cause of postoperative deficits than in younger patients, but CE is appropriate for selected octogenarians on the basis of physiologic rather than chronologic age.
为评估颈动脉内膜切除术（CE）在80岁及以上患者中的作用，我们对172例非随机选择的患有脑血管疾病的八旬老人进行了为期8年的研究。90例八旬老人接受了CE，而82例经血管造影确诊患有颈动脉疾病的八旬老人未接受手术，作为对照系列。CE术后的卒中率为6%。在长达8年的随访中，晚期卒中率仅为2%，而未手术组的累积长期卒中率为16%。这些晚期卒中与血管造影显示疾病的一侧相符。在同一时间段内接受CE的1008例非八旬老人中，CE术后的卒中率为2%，死亡率为0.6%。然而，在八旬老人群体中，手术组卒中后的死亡率高达40%，非手术对照组为62%。在接受手术的八旬老人中，53%以及所有术后出现神经功能缺损的患者中，血管造影显示存在颅内血流受限（狭窄大于75%）性闭塞性疾病。这种严重颅内疾病的发生率几乎是非八旬老人接受CE患者的五倍。尽管八旬老人患者CE术后的卒中率为6%，但与未手术的八旬老人患者16%的累积卒中率相比，晚期卒中率仅为2%。严重颅内闭塞性疾病以及因此导致的血流阻断，作为术后神经功能缺损的原因，可能比在年轻患者中发挥更重要的作用，但基于生理年龄而非实际年龄，CE对选定的八旬老人是合适的。
