July 18, 2005

Stroke prevention surgery safe for 90-year-olds

NEW YORK (Reuters Health) - Carotid endarterectomy (CEA), a
type of surgery that may help prevent strokes, can be safely
performed in elderly individuals, new research suggests.

Ideally, however, the operation should be limited to
patients who are medically fit and are experiencing symptoms
from a narrowed carotid artery.

The carotid arteries, which lie on each side of the neck,
are the major vessels that supply blood to the brain. Strokes
can occur when plaques that have formed in the carotids break
off or otherwise obstruct blood flow to the brain. CEA involves
making a small incision in the affected artery and inserting an
instrument to remove the plaque.

Evidence from two major trials, one in North America and
one in Europe, has suggested that older patients derive a
greater benefit from CEA than younger ones. However, neither
trial included patients in their 90s.

In the present study, reported in the Archives of Surgery,
Dr. Quentin J. Durward and colleagues, from the Center for
Neurosciences, Orthopaedics & Spine, PC in Dakota Dunes, South
Dakota, describe the outcomes of 26 patients, 89 years of age
and older, who underwent CEA at their center since 1995.

Except for three patients, all of the subjects had symptoms
of low blood flow to the brain. Four patients had plaque
build-up in both carotid arteries and, therefore, underwent two
CEAs each.

Despite their advanced age, none of the subjects
experienced brain or heart complications during or after
surgery, the authors note. On average, patients were
hospitalized for 2 days. One patient developed vocal cord
paralysis, but it resolved over time.

After two years, four patients had died from
non-stroke-related causes and the remainder were alive.

"We believe CEA should be considered in nonagenarian
patients" with severe carotid narrowing that causes symptoms,
the authors conclude, provided the patients are otherwise well
medically. "Our recommendations are less certain" in cases in
which there's narrowing, but no symptoms, the team says.

SOURCE: Archives of Surgery, July 2005.