OBJECTIVE
A retrospective analysis of the results of carotid endarterectomy (CEE) in different age groups.
MATERIAL AND METHODS
A cohort comparative retrospective open-label study was performed in 2008—2020 and included 7248 patients with internal carotid artery stenosis who underwent CEE. According to WHO classification, patients were divided into various age groups: up to 44 years (n=84); 45—60 years old (n=1635); 61—75 years old (n=4817); over 75 years old (n=712).
RESULTS
According to clinical-anamnestic and angiographic characteristics of patients, an expected tendency of more severe comorbidities in elder patients was observed. The largest number of all cardiovascular events was noted among patients over 75 years old. Mortality (group 1 — 0%; group 2 — 0.55% (n=9); group 3 — 0.3% (n=14); group 4 — 1.0% (n=7); p=0.037), incidence of myocardial infarction (MI) (group 1 — 1.2% (n=1); group 2 — 0.79% (n=13); group 3 — 0.54% (n=26); group 4 — 2.0% (n=4); p=0.0006), ischemic stroke (group 1 — 0%; group 2 — 1.34% (n=22); group 3 — 0.77% (n=37); group 4 — 1.7% (n=12); p=0.03), combined endpoint (death + MI + ischemic stroke) (group 1 — 1.2% (n=1); group 2 — 2.7% (n=44); group 3 — 1.6% (n=77); group 4 — 4.6% (n=33); p<0.0001), exploration for bleeding (group 1 — 1.2% (n=1); group 2 — 0.42% (n=7); group 3 — 0.33% (n=16); group 4 — 2.4% (n=17); p<0.0001) was higher in older patients compared to those aged 60—74 years. Incidence of MI, combined endpoint and exploration for bleeding in this group was higher than in patients 45—59 years old. According to binary logistic regression with stepwise inclusion and exclusion of predictors, risk factors of in-hospital complications were age over 75 years (OR 3.15; 95% CI 1.82—3.93), multiple-vessel coronary artery disease (OR 3.73; 95% CI 0.61—7.98), atrial fibrillation (OR 3.49; 95% CI 1.48—6.15), EuroSCORE II >6 (OR 2.78; 95% CI 1.57—5.86). Predictors of ischemic stroke were bilateral ICA stenosis (OR 2.71; 95% CI 1.16—4.82), ICA clamping over 50 min (OR 2.88; 95% CI 1.18—5.69). Protective factor was temporary intraoperative bypass (OR 0.33; 95% CI 0.20—0.78). Incidence of complications was similar after various techniques of CEE.
CONCLUSION
The largest number of adverse cardiovascular events after CEE is observed among patients over 75 years old due to high incidence of multiple-vessel coronary lesions, atrial fibrillation and severe comorbidities.
