Ouriel K, Penn T E, Ricotta J J, May A G, Green R M, DeWeese J A
Surg Gynecol Obstet. 1986 Apr;162(4):334-6.
Although the segment of the population at the highest risk for cerebral ischemic events is more than 75 years old, there has been hesitancy in performing carotid revascularization in these patients because of an increased risk of perioperative morbidity. Over a period of 54 months, 77 (16 per cent) of 470 carotid endarterectomies performed were upon patients more than 75 years old. There were no differences between age groups with respect to perioperative morbidity or mortality, with three strokes (3.9 per cent) and no deaths in the patients more than 75 years old and 12 strokes (3.1 per cent) and two deaths (0.5 per cent) in the patients less than 75 years old. Postoperative follow-up study ranged from 30 days to five years (a mean of 25 months) in elderly patients. The over-all three and five year survival rate was 78 and 60 per cent, respectively. No patient experienced a stroke during follow-up study. Recurrent symptoms developed in 18 per cent of the elderly patients at three years of follow-up study, and the occurrence was dependent upon the preoperative symptom category (hemispheric 10 per cent and nonhemispheric 33 per cent). We conclude that the low perioperative morbidity and mortality, and subsequent results of carotid endarterectomy in the elderly patient justify operative intervention when significant lesions are encountered.
虽然脑缺血事件风险最高的人群是75岁以上的老年人，但由于围手术期发病风险增加，对这些患者进行颈动脉血运重建一直存在犹豫。在54个月的时间里，470例颈动脉内膜切除术中，有77例（16%）是针对75岁以上的患者。不同年龄组在围手术期发病率或死亡率方面没有差异，75岁以上患者中有3例中风（3.9%），无死亡病例；75岁以下患者中有12例中风（3.1%），2例死亡（0.5%）。老年患者术后随访时间为30天至5年（平均25个月）。总体三年和五年生存率分别为78%和60%。随访研究期间没有患者发生中风。在三年的随访研究中，18%的老年患者出现了复发症状，其发生率取决于术前症状类别（半球症状患者为10%，非半球症状患者为33%）。我们得出结论，老年患者颈动脉内膜切除术围手术期发病率和死亡率较低，且后续结果表明，当遇到明显病变时，手术干预是合理的。
