Carotid surgery in patients older than 80 years. Experience in Strasbourg from 1990 to 1995.

Objective: to analyze medium- and long-term outcomes of carotid artery surgery in subjects older than 80 years and to discuss the appropriateness of such procedures in this age group. Methods: retrospective study of the 124 patients older than 80 years who underwent carotid revascularization during a five-year period, These patients contributed more than 10% of the 1171 carotid revascularization procedures done during the study period. Mean age was 82.6 years, 69% were male, 58% were symptom-free, and 36% had a history of transient ischemic attack, All procedures were done under general anesthesia with EEG monitoring. Conventional endarterectomy was done in 59% of cases and eversion endarterectomy in 37%. The contralateral carotid artery showed thrombosis in nine cases and significant stenosis in 20. Three patients underwent concomitant coronary bypass surgery, and one had aortic valve replacement. Results: one patient died after a combined carotid-coronary bypass procedure from low-output syndrome, one had a stroke in the immediate postoperative period, and a third developed a hemorrhagic stroke during an episode of paroxysmal hypertension three days after surgery, The combined morbidity-mortality rate was 2.4% per procedure. Conclusion: the complication rate in our octogenarians was not higher than that reported in younger patients. Carotid surgery is reasonable in elderly subjects carefully selected based on general and neurologic status.