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From the JAMA Network |

Outcomes of Carotid Endarterectomy and Stenting in Elderly Patients

Bruce A. Perler, MD, MBA1,2
[+] Author Affiliations
1Johns Hopkins University School of Medicine, Baltimore, Maryland
2Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
JAMA. 2014;311(12):1244-1245. doi:10.1001/jama.2014.908.
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JAMA Surgery

Meta-analysis and Meta-Regression Analysis of Outcomes of Carotid Endarterectomy and Stenting in the Elderly

George A. Antoniou, MD, PhD, FEBVS; George S. Georgiadis, MD, PhD; Efstratios I. Georgakarakos, MD, PhD; Stavros A. Antoniou, MD; Nikos Bessias, MD; John Vincent Smyth, MCh, FRCS; David Murray, MD, FRCS; Miltos K. Lazarides, MD, FEBVS

Importance: Uncertainty exists about the influence of advanced age on the outcomes of carotid revascularization.

Objective: To undertake a comprehensive review of the literature and conduct an analysis of the outcomes of carotid interventions in the elderly.

Design and Setting: A systematic literature review was conducted to identify articles comparing early outcomes of carotid endarterectomy (CEA) or carotid stenting (CAS) in elderly and young patients.

Main Outcomes and Measures: Combined overall effect sizes were calculated using fixed or random effects models. Meta-regression models were formed to explore potential heterogeneity as a result of changes in practice over time.

Results: Our analysis comprised 44 studies reporting data on 512 685 CEA and 75 201 CAS procedures. Carotid stenting was associated with increased incidence of stroke in elderly patients compared with their young counterparts (odds ratio [OR], 1.56; 95% CI, 1.40-1.75), whereas CEA had equivalent cerebrovascular outcomes in old and young age groups (OR, 0.94; 95% CI, 0.88-0.99). Carotid stenting had similar peri-interventional mortality risks in old and young patients (OR, 0.86; 95% CI, 0.72-1.03), whereas CEA was associated with heightened mortality in elderly patients (OR, 1.62; 95% CI, 1.47-1.77). The incidence of myocardial infarction was increased in patients of advanced age in both CEA and CAS (OR, 1.64; 95% CI, 1.57-1.72 and OR, 1.30; 95% CI, 1.16-1.45, respectively). Meta-regression analyses revealed a significant effect of publication date on peri-interventional stroke (P = .003) and mortality (P < .001) in CAS.

Conclusions and Relevance: Age should be considered when planning a carotid intervention. Carotid stenting has an increased risk of adverse cerebrovascular events in elderly patients but mortality equivalent to younger patients. Carotid endarterectomy is associated with similar neurologic outcomes in elderly and young patients, at the expense of increased mortality.

JAMA Surg. 2013;148(12):1140-1152. doi:10.1001/jamasurg.2013.4135

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