0
Invited Critique |

Carotid Endarterectomy as the Criterion Standard in High-Risk Elderly Patients—Invited Critique

Bruce A. Perler, MD, MBA
Arch Surg. 2008;143(8):742. doi:10.1001/archsurg.143.8.742.
Text Size: A A A
Published online

Extract

During the next 15 years, the number of individuals older than 65 years will increase by 50% and, during the next 40 years, that group will grow by 135%. The most rapid increase will be among our oldest elderly, those older than 75 years. Furthermore, individuals older than 75 years have 5 to 6 times the stroke incidence of younger adults. Selecting the most appropriate treatment of carotid disease in this demographic group is a critically important health care issue.

Because NASCET1 and ACAS2 excluded elderly individuals from randomization, it has been assumed over the years by some, and in particular today by advocates of CAS, that elderly patients a priori are at increased risk of CEA complications and perhaps would be better served by CAS. The report by Suliman et al adds to a voluminous literature published during the past 20 years refuting that premise. In a series of 117 CEAs performed on 110 patients 75 years or older by 12 different surgeons during a 16-year period, the combined stroke and death rate was only 2.6%. These results are particularly remarkable when one considers that 50.4% of these patients underwent CEA for symptomatic carotid artery disease.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Evidence Summary and Review 5

The Rational Clinical Examination
Updated Literature Search

brightcove.createExperiences();