高齢者頸動脈狭窄症に対する頸動脈ステント留置術  [in Japanese] Clinical Results of Carotid Artery Stenting for Elderly Patients with Carotid Stenosis  [in Japanese]

Carotid artery stenting (CAS) is often considered the preferred treatment for severe carotid occlusive disease in patients labelled as "high risk," including those aged 75 or more. We analyzed 30-day stroke risk and death rates after carotid artery stenting (CAS) for severe symptomatic or asymptomatic carotid stenosis in 55 patients (60 lesions) aged 75 or more and compared the results with those of 119 patients (130 lesions) less than 75 years old. All procedures were performed with protection devices (balloon protection) and were technically successful. Peri-procedural mortality and morbidity of CAS for elderly patients were 1.7% and 6.7%, respectively, but those for younger patients were 0% and 2.3%, respectively. The elderly patients tended to have a high complication rate, although it was not statistically significant. Therefore there was no significant difference in clinical baseline characteristics between the 2 groups. Randomized data that establish the efficacy of CEA versus medical management are not available for elderly patients, especially for individuals aged 80 years or older. Octogenarians should be considered high-risk patients for CAS. Randomized trial data are needed to compare the CAS versus CEA peri-procedural risk of stroke and death by age. Pending results from randomized studies, care should be exercised in selecting octogenarians for CAS.