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(Circulation. 2009;119:2302-2304.)
© 2009 American Heart Association, Inc.

Editorial

Carotid Stenting in the Elderly

Is 80 the New 60?

Michael Belkin, MD; Deepak L. Bhatt, MD, MPH

Brigham and Women’s Hospital and the VA Boston Healthcare System, Harvard Medical School, Boston, Mass.

Correspondence to Michael Belkin, MD, Chief of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115. E-mail mbelkin@partners.org

Key Words: Editorials • carotid arteries • stenosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Elderly patients are at higher risk of procedural complications. Surgical revascularization has been performed successfully in selected octogenarians.^1,2 Nevertheless, it is widely believed that percutaneous approaches are safer in the elderly. Indeed, percutaneous coronary intervention is now successfully being performed even in selected nonagenarians.³ Thus, it is tempting to presume that carotid revascularization in the elderly might be safer if done via endovascular means (Figure).⁴

View larger version (66K):   Figure. Angiography before (A) and after (B) a right carotid artery stent in an 81-year-old man with amaurosis fugax.

Article see p 2343

The data to date, however, have been conflicting, with several reports demonstrating very high rates of stroke or death with carotid stenting in octogenarians. Furthermore, although carotid stenting with embolic protection has been shown to be noninferior to carotid endarterectomy in patients at high surgical risk, whether carotid stenting is equivalent to carotid endarterectomy remains an open question in patients at low surgical risk.^5–7 Additionally, especially for asymptomatic patients, the question arises whether a patient will live long enough to derive potential benefit from any procedure. This question becomes more pressing as the elderly population expands and the definition of elderly creeps upward, and also as clinical trials continue to underenroll the elderly. The cut point where appropriate clinical caution turns instead into preconceived notions and age-related bias is difficult to define.

In this issue of Circulation, Chiam et al report on 142 consecutive patients aged 80 years or older who underwent carotid stenting.⁸ This series of patients has . . . [Full Text of this Article]

Related Article:

One-Year Clinical Outcomes, Midterm Survival, and Predictors of Mortality After Carotid Stenting in Elderly Patients

Paul T.L. Chiam, Gary S. Roubin, Georgia Panagopoulos, Sriram S. Iyer, Richard M. Green, Christina Brennan, and Jiri J. Vitek
Circulation 2009 119: 2343-2348. [Abstract] [Full Text]

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				Should Carotid Stenting Be Performed in Octogenarians? Journal Watch Cardiology, June 10, 2009; 2009(610): 4 - 4. [Full Text]