Masaru Abiko1, Shigeyuki Sakamoto2, Junichiro Ochiai3, Naoto Yamada3, Kazuhiko Kuroki3, Kaoru Kurisu2. 1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: tenmab_s@yahoo.co.jp. 2. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 3. Department of Neurosurgery, JA Hiroshima General Hospital, Hiroshima, Japan.
Abstract
BACKGROUND: A meta-analysis found that for internal carotid artery stenosis procedures in elderly patients, the risk of perioperative stroke is significantly greater for carotid artery stenting (CAS) than for carotid endarterectomy. We retrospectively examined characteristics and perioperative results of CAS for patients 80 years and older at a single medical center. METHODS: A total of 97 patients with internal carotid artery stenosis underwent CAS using the dual-protection (simultaneous flow reversal and distal filter) and blood-aspiration method. We divided patients into 2 groups, octogenarian and non-octogenarian. We evaluated patient background, captured visible debris, in-stent protrusion, major adverse events (i.e., major stroke and death), and hyperintense spots on diffusion-weighted images after CAS. RESULTS: The success rate of the CAS procedure was 100% with no major adverse events within 30 days. We found vulnerable plaque in 50% (15/30 patients) and 26.9% (18/67 patients) of octogenarian and non-octogenarian groups, respectively (P = 0.047). Diffusion-weighted images revealed small hyperintense spots in 20% (6/30 patients) and 18.0% (12/67 patients) of the octogenarian and non-octogenarian groups, respectively (P = 0.785). Visible debris was observed in 43.3% (13/30 patients) and 22.4% (15/67 patients) of the octogenarian and non-octogenarian groups, respectively (P = 0.004). CONCLUSIONS: The plaque of carotid stenosis in octogenarians is often vulnerable, but using a dual protection and blood aspiration method, we safely performed CAS in octogenarian patients.
BACKGROUND: A meta-analysis found that for internal carotid artery stenosis procedures in elderly patients, the risk of perioperative stroke is significantly greater for carotid artery stenting (CAS) than for carotid endarterectomy. We retrospectively examined characteristics and perioperative results of CAS for patients 80 years and older at a single medical center. METHODS: A total of 97 patients with internal carotid artery stenosis underwent CAS using the dual-protection (simultaneous flow reversal and distal filter) and blood-aspiration method. We divided patients into 2 groups, octogenarian and non-octogenarian. We evaluated patient background, captured visible debris, in-stent protrusion, major adverse events (i.e., major stroke and death), and hyperintense spots on diffusion-weighted images after CAS. RESULTS: The success rate of the CAS procedure was 100% with no major adverse events within 30 days. We found vulnerable plaque in 50% (15/30 patients) and 26.9% (18/67 patients) of octogenarian and non-octogenarian groups, respectively (P = 0.047). Diffusion-weighted images revealed small hyperintense spots in 20% (6/30 patients) and 18.0% (12/67 patients) of the octogenarian and non-octogenarian groups, respectively (P = 0.785). Visible debris was observed in 43.3% (13/30 patients) and 22.4% (15/67 patients) of the octogenarian and non-octogenarian groups, respectively (P = 0.004). CONCLUSIONS: The plaque of carotid stenosis in octogenarians is often vulnerable, but using a dual protection and blood aspiration method, we safely performed CAS in octogenarian patients.