Carotid endarterectomy in the elderly patient.

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.