Recently, because of the rapidly aging society, carotid endarterectomy (CEA) is increasingly being performed in elderly patients. Because previous randomized clinical trials excluded very elderly patients, the exact benefits and risk of CEA in elderly patients remain unclear. Therefore, we performed a comparative investigation of the perioperative and long-term outcomes of CEA in patients aged < 70 years (young group; n = 60) and those aged ≥ 70 years (elderly group; n = 57) in 117 consecutive patients who underwent CEA at our hospital from 2002.
There were no significant differences in preoperative risk factors between the two groups.
With respect to perioperative outcomes, mortality and the incidence of cardiovascular events were 0% in both groups. The procedure was performed safely in both groups, with cerebral infarction occurring in only one patient in the elderly group. The mean follow-up was 55 months for the young group and 35 months for the elderly group. The incidence of cerebral stroke during follow-up was 4/60 (7%) in the younger group and 3/57 (5%) in the elderly group, with no significant difference. However, there were two deaths in the young group and seven in the elderly group (five because of a malignant tumor and two because of pneumonia), that is, significantly more deaths in the elderly group.
CEA in our hospital was safe for elderly patients, who had similarly low rates of perioperative complications and cerebral infarction as those in young patients. Regarding long-term outcomes, however, more deaths occurred in the elderly group, suggesting that more appropriate patient selection is required.