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                                                                                          Dott. Carlo Sebastiano Tadeo
                                                                                                Specialista Neurologia

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Very Old Can Benefit From Carotid Surgery

Lancet

12/04/2001


Elderly patients who have a 50 percent to 99 percent symptomatic carotid stenosis have been found to benefit more from carotid endarterectomy than do younger patients.

"These good results can only be achieved in elderly patients after a scrupulous clinical evaluation to exclude disorders that could put the patients at increased risk from anesthesia or of immediate cardiac complications, and with endarterectomy done by skilled surgeons," declares Dr. Henry Barnett and colleagues at the John P. Robarts Research Institute, London, Ontario, Canada.

Although surgery has long been contraindicated in elderly people who are often thought of as too frail to survive the invasive procedures the clinicians point out that an emphasis among many doctors is to "ensure that elderly people are given the best medical care and that they are not denied treatment strategies known to be effective, simply because of their age."

At a conference last year of the American Heart Association, "the consensus of the participants was that aggressive treatment can add years of useful life in elderly patients," the report adds. "If elderly people are denied therapy for reasons of prejudice and not of science, they may justifiably feel that they have been abandoned on the basis of age alone."

In the current study 350 patients aged 75 years or older from the North American Symptomatic Carotid Endarterectomy Trial were compared with those aged between 65 and 74 years, and under the age 65, for baseline characteristics and risk of ipsilateral ischaemic stroke at two years by degree of stenosis and treatment group.

Clinicians, found among patients with 70 percent to 99 percent stenosis, the absolute risk reduction of ipsilateral ischaemic stroke with carotid endarterectomy was 28.9 percent for 71 patients aged 75 years or older, 15.1 percent for 285 patients aged 65 to 74 years, and 9.7 percent for the 303 patients in youngest group.

Among patients with 50 percent to 69 percent stenosis, the absolute risk reduction was significant only in 145 patients aged 75 years and older.

Perioperative risk of stroke and death at any degree of stenosis was 5.2 percent for the oldest group, 5.5 percent for those aged between 65 and 74, and 7.9 percent for those under the age of 65.

The authors points out that 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," they conclude.


Lancet 2001;357:1154-60.

 

            

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Aggiornato il: 18 November 2001