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Home > Vascular Annual Meeting^® > PVSS22. Cerebral Reserve Is Decreased In Elderly...

PVSS22. Cerebral Reserve Is Decreased In Elderly Patients with Carotid Stenosis

Rabih A Chaer, MD; James Shen, BS; Atul Rao, MD; Jae S Cho, MD; Ghassan Abu Hamad, MD; Michel S. Makaroun, MD
University of Pittsburgh, Pittsburgh, PA

OBJECTIVES: Octogenarians and even patients over 70 have unexplained poor outcomes with carotid angioplasty and stenting (CAS). We sought to evaluate whether older patients may have compromised intracranial collaterals and cerebral reserve (CR) and be intolerant to otherwise clinically silent emboli generated during CAS.

METHODS: 1,024 Cerebral blood flow (CBF) studies performed between 1991 and 2001 with stable xenon computed tomography scans (Xe/CT) were reviewed. CBF was measured before and after 1 gm IV Acetazolamide (ACZ), a cerebral vasodilator. The normal response to ACZ is an increase in CBF. In areas of significant compromise of CR, CBF drops representing a "steal" phenomenon. CBF changes were categorized as normal or abnormal. Age, gender, cerebral symptoms, intracranial, carotid and vertebral disease were evaluated (Table 1). Logistic regression was used to determine the effect of age on CR in the entire group and a subgroup of 179 patients with significant carotid stenosis > 50%.

RESULTS: 916 studies were suitable for analysis. Carotid occlusion was predictive of decreased CR (OR 3.9, p=0.03) regardless of age. There was also a trend with severe carotid stenosis >70% (OR=3) and women (OR=1.8) (p=0.08). Age≥70 had no effect on CR in a heterogeneous population with and without carotid disease; neither did a history of stroke, carotid or intracranial stenosis. Age≥70 was not predictive of carotid, vertebral or intracranial occlusive disease. In patients with significant carotid stenosis (n=179), age≥70 was predictive of poor CR (OR=2.7, p=0.03), so was the presence of PVD (OR=3.7, p=0.03). This trend was also seen in women (OR=2.3, p=0.08). Previous stroke, MI, CHF, diabetes, intracranial or vertebral stenosis, race and statin therapy were not.

CONCLUSIONS: Age≥70 is associated with poor cerebral reserves in patients with significant carotid stenosis as measured by CBF response to an ACZ challenge. Patients≥70 may be more sensitive to minor cerebral emboli and could therefore be at a higher risk of stroke during CAS.

AUTHOR DISCLOSURES: R.A Chaer, MD, J. Shen, None; A. Rao, None; J.S. Cho, None; G.A. Hamad, None; M.S. Makaroun, None.

Table 1.