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Invited Critique |

Carotid Endarterectomy in Elderly Patients—Invited Critique

M. Ashraf Mansour, MD
Arch Surg. 2002;137(11):1288. doi:10.1001/archsurg.137.11.1288.
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That CEA is superior to medical therapy alone in the treatment of symptomatic and asymptomatic patients with severe carotid artery stenosis is well supported in the literature. The European Carotid Surgery Trial1 and the North American Symptomatic Carotid Endarterectomy Trial2 demonstrated the beneficial effects of surgical over medical treatment in patients with symptomatic carotid artery stenosis of more than 70%, and the Asymptomatic Carotid Atherosclerosis Study3 reached the same conclusion in patients with asymptomatic stenosis of more than 60%. Closer scrutiny of the data revealed a greater benefit in men vs women, younger vs older patients, and in patients with the worst vs least stenosis.4 None of these level 1 studies included octogenarians. Furthermore, hospitals and surgeons participating in the trials were carefully selected by the study organizers to include only centers of excellence. Thus, it is appropriate to examine the outcome of CEA performed in octogenarians in a community hospital setting.

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