Safety From Acute Carotid Revascularization in Octogenarians With Recently Symptomatic Carotid Stenosis.

Background: Old age is a main factor increasing perioperative risks especially in emergency. Guidelines recommend performing carotid endarterectomy (CEA) in the acute period after onset of a transient ischemic attack (TIA) or stroke. There are concerns on the benefit from acute carotid revascularization in old patients due to increased periprocedural stroke/death risks exposure during an emergency procedure that could offset the long-term benefit. This study aimed to analyze 30-day and late risk of stroke/death after acute carotid revascularization in symptomatic patients with >80years. Methods: Data of 282 consecutive patients (28.4% females; mean age 73.9y) undergoing carotid revascularization within 15 days from stroke/TIA ,in 2009-2015, were analyzed. Octogenarians and younger patients were compared for presentation, 30-day and late stroke/death rates using multivariable and survival analyses. Results: There were 79 (28%) patients with >80 years (34.2% females): 33(42%) were treated within the first 7 days and 10 (13%) within 48hours from symptom onset. Stroke was the index event in 34(43%); in 11(14%) recurrent TIA. Baseline comorbidity profile, presenting symptoms and timing of treatment were comparable between old and young patients, but the rate of preoperative cerebral infarction was lower in octogenarians: 36.2% vs. 52.5% (P=0.031).30-day stroke/death rate was 2.5% in octogenarians (2/79) and 3.4% (7/203) in younger patients (OR 0.73; 95%Cl,0.15-3.58; P=0.99).There were one 30-day death and no cerebral hemorrhage among octogenarians. No 30-day stroke/death occurred in procedures within 48h. In adjusted analyses octogenarian was not associated with increased stroke/death risk. At 4-year all cause survival was lower (58%) in octogenarians than in younger patients (91%%,P=<0.0001); freedom from stroke rates was indeed comparable (90.3% vs. 93.2%;P=0.27). Conclusions: Octogenarians undergoing carotid revascularization within the acute (15 days) or hyperacute (48 hours) period after TIA/stroke show 30-day stroke/death and 4-year stroke rates comparable to younger patients. Given the higher age-related risk of stroke exposure and recurrence, the benefit from an acute carotid treatment in octogenarians may be relevant.