International Stroke Conference Oral Presentations

Carotid Stenosis in Patients with Over 80 Years: is there a Benefit from Carotid Revascularization in Stroke Prevention? Paola De Rango, Massimo Lenti, Enrico Cieri, Giuseppe Giordano, Gioele Simonte, Vascular and Endovascular Surgery Unit, Univ of Perugia, Perugia, Italy; Piergiorgio Cao; Vascular Surgery, Dept of Cardioscience, Hosp S. Camillo-Forlanini, Rome, Italy Objective: Management of 80 year patients with carotid stenosis is questionable: despite the stroke risk increases with age , benefit of treatment needs to be balanced with increased perioperative risks and decreased overall survival related to advanced age. The purpose of this study was to evaluate periprocedure risks and late outcomes in octogenarian patients treated for severe carotid stenosis. Methods: From 2001 to 2010, consecutive patients with 80 years undergoing carotid endarterectomy (CEA) or carotid stenting (CAS) after training period, were reviewed. Clinical end-points were perioperative complications and survival. Mortality rates were compared with those of octogenarians according to all cause- and stroke-relatedmortality tables of statistic Nationwide survey in the population of the same territory. Results: . 348 patients (272males) with severe carotid stenosis and 80 years were treated, 162(46.5%) by CAS. 197 (57%) patients were symptomatic before treatment. Perioperative occurrence of stroke/death/myocardial infarction was 5.5% (19/348) and was similar regardless of procedure or gender. After a mean follow- up of 42 months, 101 deaths occurred for overall mortality of 29.0% (23% females, 30.5% males; p0.3). 25 (7.1%) late stroke occurred (13% females, 5.5% males). Stroke related mortality was 4.9% (17/348): 7.9% in females and 4.0% in males (p0.2). The proportion of mortality stroke related was 16.8% (17/101) and higher in females. Corresponding figures from Nationwide survey in 80 population showed at 48 months mortality rate of 39.0% (34.8% females, 46.4% males) and stroke related mortality rate of 6.8% (6.6% females, 7.1% males). The proportion of mortality stroke-related was 17.4% and higher in females (19%) vs males (15.3%). Conclusions: Carotid revascularization can be performed in patients with 80 years with low operative complications. However, despite the high prevalence and fatality rate of stroke in octogenarians, long-term benefit of carotid revascularization is debatable. Treatment of carotid stenosis might not be warranted especially when asymptomatic.