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Study finds stroke-prevention surgery safe in growing 80-plus population
October 10, 2008New research published in the October issue of Journal of the American College of Surgeons challenges the current opinion that patients in their eighties, who are often deemed "high-risk" due to their advanced age, should not undergo carotid endarterectomy - a stroke-preventing surgical procedure that clears blockages from the neck's carotid arteries.
Approximately 700,000 new and recurrent strokes occur annually in the United States, and it is estimated that 10 to 20 percent of them are related to carotid artery disease.
Several clinical trials have suggested that carotid endarterectomy can be used to safely and effectively prevent strokes in patients younger than 80 years of age. However, because of the perception that patients in their eighties and nineties are at increased risk, clinicians have recommended that these patients receive alternative treatments such as stenting.
"Age alone should not place patients in the high-risk category for carotid endarterectomy," said study authors Steven Katz, MD, FACS, and Amy Bremner, MD, of the Huntington Hospital, Pasadena, CA, and the Keck School of Medicine, Los Angeles, CA. "As the elderly population surges, it is crucial to identify strategies that can potentially limit the devastating consequences of stroke and its impact on the health care budget. Our study shows that carotid endarterectomy remains the treatment of choice in patients 80 years of age and older with substantial blockage of the carotid arteries."
The retrospective study, which analyzed the outcomes of 103 carotid endarterectomies in 95 patients between the ages of 80 and 94 years (59 men and 36 women; mean age = 83.7 years), showed a low incidence of neurologic complications, with only one transient ischemic attack (0.97 percent), two minor strokes (1.94 percent) and one major stroke (0.97 percent). There were no deaths within 30 days of operation. The combined stroke and death rate was 2.91 percent.
Weber Shandwick Worldwide
"Age alone should not place patients in the high-risk category for carotid endarterectomy," said study authors Steven Katz, MD, FACS, and Amy Bremner, MD, of the Huntington Hospital, Pasadena, CA, and the Keck School of Medicine, Los Angeles, CA. "As the elderly population surges, it is crucial to identify strategies that can potentially limit the devastating consequences of stroke and its impact on the health care budget. Our study shows that carotid endarterectomy remains the treatment of choice in patients 80 years of age and older with substantial blockage of the carotid arteries."
The retrospective study, which analyzed the outcomes of 103 carotid endarterectomies in 95 patients between the ages of 80 and 94 years (59 men and 36 women; mean age = 83.7 years), showed a low incidence of neurologic complications, with only one transient ischemic attack (0.97 percent), two minor strokes (1.94 percent) and one major stroke (0.97 percent). There were no deaths within 30 days of operation. The combined stroke and death rate was 2.91 percent.
Weber Shandwick Worldwide
Carotid Endarterectomy Current Events and Carotid Endarterectomy News RSSStudy examines impact of managed care on stroke prevention surgery
Policymakers and economists often promote managed-care plans based on the assumption that they prevent the overuse of unnecessary surgical procedures or help steer patients to high-quality providers, compared to traditional fee-for-service insurance plans.
Surgery unnecessary for 95 percent of those with asymptomatic carotid stenosis
Research led by Dr. David Spence of Robarts Research Institute at The University of Western Ontario shows that with more intensive medical therapy, the risk of stroke has become so low that at least 95 per cent of patients with asymptomatic carotid stenosis (ACS) would be better off with medical therapy than with surgery or stenting.
For high-risk patients, stroke-prevention surgical procedure does not equate with high surgical risk
New research published in the August issue of the Journal of the American College of Surgeons shows that "high-risk" patients with multiple medical conditions, including high blood pressure and coronary artery disease, can safely undergo carotid endarterectomy - a stroke-preventing surgical procedure that clears blockages from the neck's carotid arteries.
Scientists develop new techniques for detecting harmful blood clots/air bubbles in arteries
New techniques for detecting emboli (harmful blood clots/air bubbles in arteries) developed at the University of Leicester have played a major role in dramatically reducing stroke rates after carotid endarterectomy. This is an operation designed to remove narrowings in the main arteries supplying the brain before they can cause a stroke.
Vascular surgeons ask, what's next for carotid artery stenting?
A procedure called carotid artery stenting (CAS) has emerged as a minimally invasive alternative to surgery, called carotid endarterectomy (CEA), for patients with dangerous narrowing of the arteries supplying blood to the brain.
Arterial vascular disease underdiagnosed, undertreated in older US women
Though arterial vascular disease is widespread and often deadly among older American women, doctors too often fail to spot and treat it, according to a new report by a team of vascular surgeons from the Columbia University Medical Center and Weill Cornell Medical College campuses of NewYork-Presbyterian Hospital.
2 carotid artery stenting studies show results comparable to AHA guidelines
Two carotid stenting trials examining patient outcomes demonstrated results that are comparable to guidelines established by the American Heart Association (AHA) for patients treated with carotid artery surgery.
Cerebral embolic protection and carotid stent systems
High-risk surgical patients in community hospital settings can safely benefit from the use of new embolus-removing and stent-inserting systems, according to a study presented today at the American College of Cardiology's Innovation in Intervention: i2 Summit in New Orleans, La.
Risk of death increases with combined heart and stroke prevention surgery
Patients who undergo combined heart bypass surgery and carotid endarterectomy, the most commonly used stroke prevention surgery, significantly increase their chances of death or stroke.
Fewer patients undergoing stroke prevention surgery for wrong reasons
A new study has found a drop in the number of patients undergoing the most commonly used stroke prevention surgery, carotid endarterectomy, for inappropriate reasons. Researchers are crediting the drop to highly publicized randomized controlled trials (RCTs) that clarified the appropriate use of the surgery.
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