Carotid endarterectomy and ultrasound-guided local anesthesia in octogenarians

Carotid endarterectomy (CEA) is proven to be an effective treatment for carotid artery stenosis but for old patients it remains controversial. Carotid angioplasty and stenting (CAS) has emerged as an alternative treatment, although recent reports show increased adverse periprocedural outcome for CAS. We evaluated our single-institution experience with CEA in patients > 80 years and regional anesthesia of the regio colli. All patients who underwent CEA between January 2005 and March 2009 were evaluated. Perioperative morbidity and mortality including neurologic events were recorded. Seventy-three patients were analyzed. The mean age was 84.9 years. Sixty-seven patients (91.8%) underwent ultrasound-guided regional anesthesia. Conversion to general anesthesia was necessary in one case (1.4%). During the 30-day postprocedural period, no new neurologic events were recorded. Four patients (5.5%) required reexploration and evacuation of wound hematoma, and three cases (4.1%) were treated conservatively for wound hematoma. One (1.4%) cranial nerve injury occurred. One patient (1.4%) died due to postoperative fulminant pneumonia and cardiac insufficiency. CEA appears to be a safe procedure in patients > 80 years. CAS should not be indicated by age alone. Furthermore, ultrasound-guided regional anesthesia seems to be safe and effective in elderly patients as well.