Clinical Significance of Carotid Endarterectomy and Carotid Artery Stenting in Older Patients Over 80
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- KASHIWAZAKI Daina
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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- HORI Emiko
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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- AKIOKA Naoki
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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- MARUYAMA Kunitaka
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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- YAMAMOTO Shusuke
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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- KUWAYAMA Naoya
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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- NOGUCHI Kyo
- Departments of Radiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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- KURODA Satoshi
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
抄録
<p>As the average life expectancy increases, neurosurgeons are likely to encounter patients aged 80 years and above with carotid stenosis; however, whether old age affects clinical post-treatment outcomes of carotid endarterectomy (CEA) or carotid artery stenting (CAS) remains inconclusive. Thus, this study aimed to evaluate the outcomes following CEA or CAS in patients aged 80 years and above. This study included older over 80 years (n = 34) and younger patients (<80 years; n = 222) who underwent CEA or CAS between 2012 and 2022. All of them were followed up for a mean of 55 months. All-cause mortality, the incidence of vascular events, ability to perform daily activities, and nursing home admission rates were assessed. During follow-up periods, 34 patients (13.3%) died due to coronary artery disease, malignancy, and pneumonia, and the incidence was significantly higher in the elderly group than in the younger group (P = 0.03; HR, 3.01; 95% CI, 1.53-5.56). The incidence of vascular events did not differ between the older group (29.5%) and the younger group (26.9%, P = 0.58); however, the incidence was significantly higher in patients with high-intensity plaques than in those without that (P = 0.008; HR, 2.83, 95%CI, 1.27-4.87). The decline in the ability to perform daily activities and increased nursing home admission rates were high in elderly patients (P < 0.01). Although the mortality rate was higher in the elderly group, subsequent vascular events were comparable to that in the younger group. The results suggest that CEA and CAS are safe and useful treatments for carotid stenosis in older patients, especially to prevent ipsilateral ischemic stroke.</p>
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 64 (4), 147-153, 2024-04-15
一般社団法人 日本脳神経外科学会