Carotid artery stenting in nonagenarians: Are there benefits in surgically treating this high risk population?

Michael M. Wach, Travis M Dumont, Hakeem J. Shakir, Kenneth V. Snyder, L. Nelson Hopkins, Elad I. Levy, Adnan H. Siddiqui

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Carotid angioplasty and stenting (CAS) is considered desirable treatment for patients at high risk for carotid endarterectomy. Despite a growing elderly population, scant data exist on CAS in nonagenarians. Nonagenarians represent a high risk population for open and endovascular interventions due to unique anatomic and physiologic characteristics presenting significant challenges to anesthesiologists and surgeons. Studies have quantified that symptomatic and asymptomatic patients should survive 2 and 5 years, respectively, to gain benefit from revascularization; thus doubt exists on the value of CAS in nonagenarian patients because of their extreme age and unique risk factors. We therefore evaluated CAS safety and efficacy in our hospital's nonagenarian population. Methods: CAS cases performed in patients aged ≥90 years between April 2005 and January 2013 were retrospectively examined. Relevant demographic and medical data were reviewed. Rates of perioperative complications and complications until end of follow-up (including stroke, myocardial infarction, death) were compiled. Results: Among 21 nonagenarian cases of stent placement performed in 20 patients (11 symptomatic, nine asymptomatic), two patients suffered perioperative stroke after undergoing CAS and one died during the perioperative period. 50% of symptomatic patients were alive at 19 months; 50% of asymptomatic patients were alive at 47 months. Conclusions: CAS in nonagenarian patients carried increased risk of perioperative ischemic events, compared with contemporary trial results in symptomatic and asymptomatic patients. Further, mean survival time postprocedure fell short of guidelines for receiving procedural benefit. Although larger scale multicenter research is needed, we recommend careful consideration of overall health status when contemplating stenting in nonagenarians.

Original languageEnglish (US)
Pages (from-to)182-187
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume7
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

Carotid Arteries
Angioplasty
Population
Stroke
Perioperative Period
Carotid Endarterectomy
Health Status
Stents
Survival Rate
Myocardial Infarction
Demography
Guidelines
Safety

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Carotid artery stenting in nonagenarians : Are there benefits in surgically treating this high risk population? / Wach, Michael M.; Dumont, Travis M; Shakir, Hakeem J.; Snyder, Kenneth V.; Hopkins, L. Nelson; Levy, Elad I.; Siddiqui, Adnan H.

In: Journal of NeuroInterventional Surgery, Vol. 7, No. 3, 01.03.2015, p. 182-187.

Research output: Contribution to journalArticle

Wach, Michael M. ; Dumont, Travis M ; Shakir, Hakeem J. ; Snyder, Kenneth V. ; Hopkins, L. Nelson ; Levy, Elad I. ; Siddiqui, Adnan H. / Carotid artery stenting in nonagenarians : Are there benefits in surgically treating this high risk population?. In: Journal of NeuroInterventional Surgery. 2015 ; Vol. 7, No. 3. pp. 182-187.
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abstract = "Background: Carotid angioplasty and stenting (CAS) is considered desirable treatment for patients at high risk for carotid endarterectomy. Despite a growing elderly population, scant data exist on CAS in nonagenarians. Nonagenarians represent a high risk population for open and endovascular interventions due to unique anatomic and physiologic characteristics presenting significant challenges to anesthesiologists and surgeons. Studies have quantified that symptomatic and asymptomatic patients should survive 2 and 5 years, respectively, to gain benefit from revascularization; thus doubt exists on the value of CAS in nonagenarian patients because of their extreme age and unique risk factors. We therefore evaluated CAS safety and efficacy in our hospital's nonagenarian population. Methods: CAS cases performed in patients aged ≥90 years between April 2005 and January 2013 were retrospectively examined. Relevant demographic and medical data were reviewed. Rates of perioperative complications and complications until end of follow-up (including stroke, myocardial infarction, death) were compiled. Results: Among 21 nonagenarian cases of stent placement performed in 20 patients (11 symptomatic, nine asymptomatic), two patients suffered perioperative stroke after undergoing CAS and one died during the perioperative period. 50{\%} of symptomatic patients were alive at 19 months; 50{\%} of asymptomatic patients were alive at 47 months. Conclusions: CAS in nonagenarian patients carried increased risk of perioperative ischemic events, compared with contemporary trial results in symptomatic and asymptomatic patients. Further, mean survival time postprocedure fell short of guidelines for receiving procedural benefit. Although larger scale multicenter research is needed, we recommend careful consideration of overall health status when contemplating stenting in nonagenarians.",
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N2 - Background: Carotid angioplasty and stenting (CAS) is considered desirable treatment for patients at high risk for carotid endarterectomy. Despite a growing elderly population, scant data exist on CAS in nonagenarians. Nonagenarians represent a high risk population for open and endovascular interventions due to unique anatomic and physiologic characteristics presenting significant challenges to anesthesiologists and surgeons. Studies have quantified that symptomatic and asymptomatic patients should survive 2 and 5 years, respectively, to gain benefit from revascularization; thus doubt exists on the value of CAS in nonagenarian patients because of their extreme age and unique risk factors. We therefore evaluated CAS safety and efficacy in our hospital's nonagenarian population. Methods: CAS cases performed in patients aged ≥90 years between April 2005 and January 2013 were retrospectively examined. Relevant demographic and medical data were reviewed. Rates of perioperative complications and complications until end of follow-up (including stroke, myocardial infarction, death) were compiled. Results: Among 21 nonagenarian cases of stent placement performed in 20 patients (11 symptomatic, nine asymptomatic), two patients suffered perioperative stroke after undergoing CAS and one died during the perioperative period. 50% of symptomatic patients were alive at 19 months; 50% of asymptomatic patients were alive at 47 months. Conclusions: CAS in nonagenarian patients carried increased risk of perioperative ischemic events, compared with contemporary trial results in symptomatic and asymptomatic patients. Further, mean survival time postprocedure fell short of guidelines for receiving procedural benefit. Although larger scale multicenter research is needed, we recommend careful consideration of overall health status when contemplating stenting in nonagenarians.

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