The NASCET demonstrated the highest level of absolute risk reduction for carotid endarterectomy performed in patients 75 years and older (28.9%). Operative risk also decreased with increasing age in this trial. This, together with the increased morbidity of stroke in the elderly patients, provides a rationale for studying the effectiveness of carotid endarterectomy in nonagenarian patients. The authors are to be commended for their excellent results in treating a small subset of 26 patients 89 years or older with carotid endarterectomy; these patients were essentially devoid of perioperative stroke and cardiac morbidity. One could argue that this was a relatively healthy group of very elderly patients without the usual comorbid risk factors present in the typical vascular surgery patient population. Nevertheless, many surgeons would still consider nonagenarians to be at increased risk for perioperative complications. Because the morbidity and mortality of carotid endarterectomy has been shown to be inversely proportional to surgeon and facility volume, a case could be made for operating on such a high-risk group at regionalized centers. This is particularly relevant because unusual technical difficulties, such as high carotid bifurcations, dense adherence of surrounding tissues, and looping internal carotid arteries requiring derotation, were common.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination
Evidence Summary and Review 5
The Rational Clinical Examination
Updated Literature Search
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.