Carotid artery stenting according to the "tailored CAS" algorithm performed in the very elderly patients: The thirty day outcome

• Published in: Catheterization and cardiovascular interventions Vol. 82; no. 5; pp. 681 - 688
• Main Authors: Dzierwa, Karolina, Pieniazek, Piotr, Tekieli, Lukasz, Musialek, Piotr, Przewlocki, Tadeusz, Kablak-Ziembicka, Anna, Kosobucka-Peszat, Renata, Machnik, Roman, Trystula, Mariusz, Podolec, Piotr
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2013; Wiley Subscription Services, Inc
• Subjects: Age Factors; Aged; Aged, 80 and over; Algorithms; Angioplasty; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Angioplasty, Balloon - mortality; Asymptomatic Diseases; Cardiology; Cardiovascular disease; carotid stenosis; Carotid Stenosis - complications; Carotid Stenosis - diagnosis; Carotid Stenosis - mortality; Carotid Stenosis - therapy; cerebrovascular disease; Comorbidity; Decision Support Techniques; Female; Hospitals, High-Volume; Humans; Male; Patient Selection; Poland; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Stents; stroke; Stroke - etiology; Time Factors; Treatment Outcome; Poland; stroke; cerebrovascular disease; carotid stenosis
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.25025

Objectives To assess safety and efficacy of carotid artery stenting (CAS) according to “tailored—CAS” algorithm in the elderly (≥75 years) in relation to younger patients. Background Although CAS has grown as an alternative to carotid endarterectomy the data on safety of CAS in the very elderly are inconsistent. Material and Methods 1,139 patients with significant carotid stenosis underwent 1,252 CAS procedures in one high‐volume center between years 2001–2011. CAS procedures were performed with lesion and patient dependent selection of neuroprotection type (“tailored‐CAS”). There were 193 subjects ≥75‐years‐old (17%) and 946 <75‐years‐old. No major differences in atherosclerosis risk factors and comorbidities between groups were noted. In both groups the majority of patients were male (70.4% vs. 68.6%, P = NS) and half of the patients were symptomatic (50.2% vs. 55.2%, P = NS). Bilateral carotid stenosis was present in 25% of patients from CAS ≥75 group and 22% from CAS< 75 group, P = NS. Proximal neuroprotection devices use for high risk or symptomatic lesions accounted for 31% in CAS≥ 75 group and 32% in CAS<75 group, P = NS. Results In symptomatic patients aged ≥75 years 30‐day stroke and death rate was 7% versus 1.9% in symptomatic patients aged <75; P = 0.01 and vs. 1.8% in asymptomatic elderly, P = 0.09. No myocardial infarcts were noted. Conclusions Symptomatic elderly is a group of highest CAS risk and the use of “tailored CAS” algorithm does not equalize CAS risk in this patients' group. “Tailored CAS” remains a safe procedure for asymptomatic elderly as well as symptomatic and asymptomatic young patients. © 2013 Wiley Periodicals, Inc.