MedWire News: Three papers in the journal Catheterization and Cardiovascular Interventions support carotid artery stenting (CAS) in carefully selected patients aged 80 years or older.
The studies all include prospectively gathered data on patients who underwent CAS in single centers. The clinicians in all three studies performed CAS only in the absence of patient factors such as tortuosity of the aortic arch and cervical vessels, circumferential target lesion calcification, and intravascular thrombosis.
The first article reports on 126 CAS procedures in patients aged at least 80 years. The patients either had ≥50% symptomatic stenosis (in 40% of patients) or ≥80% asymptomatic stenosis.
During the 30 days after surgery, just 2.7% of patients suffered major adverse coronary or cerebral events, with 0.9% dying and 0.9% suffering major stroke and 0.9% minor stroke. All major events occurred in patients with symptoms at baseline.
"We believe that careful case selection and the performance of the procedure by highly experienced operators were the keys to our success," say Christopher White (Ochsner Clinic Foundation, New Orleans, Louisiana, USA) and colleagues.
In the second study, Gary Roubin (Lenox Hill Heart and Vascular Institute, New York, USA) and co-workers report on 142 patients aged at least 80 years who had either ≥50% symptomatic stenosis or ≥70% asymptomatic stenosis.
Overall, 3.3% of patients suffered stroke or died within 30 days of intervention - 5.1% for symptomatic patients and 2.6% for asymptomatic patients.
"Careful patient and lesion selection, and adherence to meticulous techniques are critical," say Roubin et al. "With these caveats, CAS should be a carotid artery revascularization option in appropriately selected elderly patients."
The third study, reported by M Henry (Cabinet de Cardiologie, Nancy, France) and team, compared the outcomes of 749 patients younger than 80 years and 121 older patients who underwent CAS.
Death, stroke, or myocardial infarction occurred in 1.8% of patients younger than 80 years and just 0.8% of the older group.
However, the researchers stress: "It is apparent that some contraindications to CAS still remain and stenting every patient is not the answer." They emphasize the importance of patient selection and good technique.
"Finally, the physician has to accept when to say no and when to walk away," they add.