There was no enough evidence to support the view that endovascular treatment could alternate the endarterectomy to be a standard treatment of carotid stenosis. A recent Cochrane systematic review found no difference in major outcomes between endovascular treatment and surgery. The randomised trials provided data to show that the main advantage of endovascular treatment for carotid artery stenosis was the avoidance of minor complications such as cranial nerve palsy and wound haematoma of surgery. Longer term follow also showed no difference in the rate of stroke during follow-up, but the confidence intervals were very wide allowing the possibility of a substantial difference in risk and benefits of the two treatments. There was no difference in avoidance of stroke between carotid stenting using protection devices and surgery, and the protection devices could cause additional complications.
ObjectiveTo summarize the experience in treating the elderly patients (≥75 years old) with carotid artery stenosis, and to evaluate the efficacy and safety of the carotid endarterectomy (CEA). MethodsThe datum of 312 cases with carotid artery stenosis and underwent the CEA in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were retrospectively analized.The risk factors of the CEA in treating the elderly patients were analized, and the measures to prevent perioperative complications were discussed. ResultsThirty-nine cases were brought into the research.The mean follow-up was (22.18±8.71) months.Thirty-three cases (84.6%) were male and 6 cases (15.4%) were female.The median age was 77 years old (75-82 years old).Eleven cases (28.2%) were with bilateral lesions, and 7 cases (17.9%) were asymptomatic.A total of 39 CEA procedures were successfully performed, 22 artificial vascular patches (56.4%) and 16 shunts (41.0%) were used.The mean average hospital stay was (17.38±5.39) days.One case showed cerebral hyperperfusion syndrome in 2th day after operation, another 1 case was found ipsilateral restenosis in 15th month after operation. ConclusionCEA is a safe and effective measure in treating the elderly patients with carotid artery stenosis, if the the indications of surgery is performed strictly.