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ELDERLY PEOPLE BENEFIT FROM CAROTID SURGERY (pp1142, 1154)

April 11, 2001

Surgery has long been contraindicated in elderly people, who are often thought of as too frail to survive the invasive procedures involved. Research published in this week’s issue of THE LANCET, however, indicates that surgery aimed at preventing stroke is actually more beneficial in older people than in younger individuals.

Henry J M Barnett from the John P Robarts Research Institute, Ontario, Canada, and colleagues compared 350 patients aged 75 years and older with younger patients, all enrolled in a large international trial investigating the advantages of surgically cleaning out the major artery implicated in stroke risk. Their findings indicate that as many elderly patients as young ones survived surgery, and that they had a lower risk of subsequent disabling stroke.

The authors explain: “The elderly who are not otherwise afflicted with failing health are candidates for surgical prevention of stroke if they have severe narrowing of the carotid artery causing their warning symptoms. They should not be sent home to take medical measures alone …. The odds of surgical benefit compared with medical care are heavily stacked in favour of surgery.”

In an accompanying Commentary (p1142) Peter M Rothwell urges: “Elderly patients commonly do not wish to undergo [surgery], but they should at least be given the choice. The trial evidence suggests that they are likely to benefit, and the published operative risks are acceptable”.

Contact: Dr Henry J M Barnett, John P Robarts Research Institute, 100 Perth Drive, PO Box 5015, London, Ontario, N6A 5K8, Canada; E) barnett@rri.on.ca

Peter M Rothwell, Department of Clinical Neurology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, UK; E) peter.rothwell@cineuro.ox.ac.uk

Lancet

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