Treatment Outcomes of Endarterectomy for Cervical Carotid Stenosis and Clinical Characteristics by Age Group

<p>Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are performed to revascularize internal carotid artery (ICA) stenosis. A comparative study between the two procedures has shown CEA to be more effective, and it is the first-line treatment for ICA stenosis. However, the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy trial showed the non-inferiority of CAS in the patient group at a high risk for CEA, among patients aged ≥ 70 years with contralateral carotid stenosis, pulmonary dysfunction, or a high cervical lesion. At our institution, the treatment outcomes and clinical characteristics of CEA efficacy and safety were classified based on age groups. We enrolled patients who underwent CEA at our hospital between January 2014 and December 2020. The patients were divided into the following age groups: ≤ 69 years, 70–79 years, and ≥ 80 years. The groups were analyzed for underlying disease, perioperative outcomes within 30 days, and the frequency of positive findings on postoperative diffusion-weighted magnetic resonance imaging. Changes in modified Rankin Scale (mRS) scores from admission to discharge were analyzed in the hyperacute (≤ 2 days), acute (3–7 days), subacute (8–30 days), and delayed (≥ 31 days) phases. In the young age group (≤ 69 years), diabetes and hypertension were the common comorbidities, while cardiac and renal issues were common for the middle (70–79 years) and older (≥ 80 years) age groups. The middle and older age groups were treated during the acute onset phase due to high acute cerebral infarction incidence arising from severe hemodynamic stroke. The mean mRS scores of these groups thereon improved. In cases of ICA stenosis due to severe hemodynamic stroke, acute revascularization procedure was observed to be effective, including by CEA, even when patients were ≥ 70 years.</p>