Lodato Marcello, Pini Rodolfo, Faggioli Gianluca, Rocchi Cristina, Gallitto Enrico, Vacirca Andrea, Gargiulo Mauro
Vascular Surgery Unit, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy.
Vascular Surgery University of Bologna DIMEC, Bologna, Italy.
J Stroke Cerebrovasc Dis. 2025 Aug;34(8):108375. doi: 10.1016/j.jstrokecerebrovasdis.2025.108375. Epub 2025 Jun 10.
Carotid endarterectomy (CEA) is the standard treatment for symptomatic carotid artery stenosis (ipsilateral cerebral ischemic symptoms in the last 3months - SCS) in patients suitable for open surgery. Given the increasing age of the general population, this treatment is performed in octogenarian patients with increasing frequency. However, this population was not included in the historical randomized controlled trials and there is a lack of available data on perioperative complications, specifically the severity of possible postoperative stroke. The aim of this study is to report the outcomes of CEA for SCS in octogenarians and to evaluate the characteristics of postoperative stroke, in comparison to non-octogenarians.
This is a retrospective analysis of patients treated with CEA from 2012 to 2023 for SCS. Patients were divided according to their age in non-octogenarian (<80year-old) and octogenarian (≥80 year-old) and compared according to type of preoperative symptoms and timing of intervention. The primary endpoints of this study were to analyze the postoperative stroke and death rate and to assess the severity of postoperative stroke in octogenarian and non-octogenarian patients using the National Institute of Health Institute of Stroke Scale (NIHSS) classification. Follow-up was performed with yearly clinical visit.
A total of 664 symptomatic patients were treated by CEA, 157(24 %) were octogenarian (mean age 84 ± 4) and had similar preoperative characteristics of non-octogenarian except for the distribution of preoperative neurological type of symptoms: transient ischemic attack (TIA) 51 %vs42 %,P = .05, amaurosis fugax (AF) 14 %vs5 %,P = .001; stroke 36 %vs53 %,P = .01. The timing between symptoms and surgery was similar between the octogenarian and non-octogenarian patients 10 ± 8vs8 ± 7 days(P = .22). The overall postoperative rate of stroke and death was 3.1 %, similar between octogenarian and non-octogenarian: 3.7 %vs.3.1 %,P = .39. The type of preoperative symptoms did not affect the outcome between older and younger patients: TIA 3.4 %vs.3.3 %,P = .63; AF 0 %vs0 %,P = .1.0 and stroke 3.5 %vs.3.3 %,P = 1.0. In octogenarian patients stroke and death rate was similar independently on the timing of CEA performance: 3.9 %, if performed within 48h, 3.7 % between 2days and 14 days and 3.4 % after 2 weeks, P = .72. Postoperative stroke rate was similar in the two groups: 15(2.9 %) in non-octogenarians and 5(3 %) in octogenarian patients (P = .1); but moderate/severe stroke (NIHSS ≥ 5) was more frequent in octogenarian patients: 2 % vs 0.4 %, P = .05 The mean follow-up was 68±14 months and at 5-year the ipsilateral stroke free survival was 97.6 % ± 4 % with no differences between octogenarian and non-octogenarian: 95.2 % ± 6 %vs98.1 % ± 3 %,P = .32.
SCS octogenarian submitted to CEA have a low rate of perioperative and follow-up events, comparable with non-octogenarian. The timing and the type of symptoms do not seem to affect the CEA outcome. However, when a postoperative stroke occurs in the older patients, its severity is greater.
对于适合开放手术的有症状颈动脉狭窄（过去3个月内出现同侧脑缺血症状——SCS）患者，颈动脉内膜切除术（CEA）是标准治疗方法。鉴于普通人群年龄不断增长，这种治疗在八旬老人中进行的频率越来越高。然而，这一人群未被纳入历史随机对照试验，且缺乏围手术期并发症尤其是术后可能发生的中风严重程度的可用数据。本研究的目的是报告八旬老人因SCS接受CEA的结果，并与非八旬老人相比评估术后中风的特征。
这是一项对2012年至2023年因SCS接受CEA治疗患者的回顾性分析。患者根据年龄分为非八旬老人（<80岁）和八旬老人（≥80岁），并根据术前症状类型和干预时机进行比较。本研究的主要终点是分析术后中风和死亡率，并使用美国国立卫生研究院卒中量表（NIHSS）分类评估八旬老人和非八旬老人患者术后中风的严重程度。每年进行临床随访。
共有664例有症状患者接受了CEA治疗，157例（24%）为八旬老人（平均年龄84±4岁），除术前神经症状类型分布外，其术前特征与非八旬老人相似：短暂性脑缺血发作（TIA）51%对42%，P = 0.05；一过性黑矇（AF）14%对5%，P = 0.001；中风36%对53%，P = 0.01。八旬老人和非八旬老人患者症状出现与手术之间的时间相似，分别为10±8天和8±7天（P = 0.22）。总体术后中风和死亡率为3.1%，八旬老人和非八旬老人相似：3.7%对3.1%，P = 0.39。术前症状类型不影响老年和年轻患者的结果：TIA 3.4%对3.3%，P = 0.63；AF 0%对0%，P = 1.0；中风3.5%对3.3%，P = 1.0。在八旬老人患者中，CEA手术时机不同，中风和死亡率相似：48小时内进行手术为3.9%，2天至14天之间为3.7%，2周后为3.4%，P = 0.72。两组术后中风率相似：非八旬老人中15例（2.9%），八旬老人患者中5例（3%）（P = 0.1）；但八旬老人患者中中度/重度中风（NIHSS≥5）更常见：2%对0.4%，P = 0.05。平均随访68±14个月，5年时同侧无中风生存率为97.6%±4%，八旬老人和非八旬老人之间无差异：95.2%±6%对98.1%±3%，P = 0.32。
因SCS接受CEA治疗的八旬老人围手术期和随访事件发生率较低，与非八旬老人相当。症状出现时间和类型似乎不影响CEA结果。然而，老年患者术后发生中风时，其严重程度更大。
