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Home > Press Center > Press Releases from 2005 Annual Meeting > Risks of Carotid Stenting Higher in Octogenarians

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Jill Goodwin
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Patients aged 80 or older are at higher risk than younger patients for major complications from carotid artery stenting, so the procedure “should be considered with caution” in this age group, according to research presented at the annual meeting of the Society for Vascular Surgery in Chicago.

Carotid artery stenting is an endovascular procedure (within the blood vessel) that uses wire-mesh tubes to expand portions of the carotid arteries that are blocked by atherosclerotic plaque. The carotid arteries, located in the neck, conduct blood from the aorta to the brain. When they are blocked by plaque, blood flow to the brain is impaired. Previous reports on the safety of carotid artery stenting in the very elderly (patients aged 80 and older) have had conflicting results, so Dr. Stephen F. Stanziale and his colleagues at the University of Pittsburgh Medical Center (Pittsburgh, Penn.) reviewed the records of 382 patients who underwent the procedure at their medical center.

A total of 87 of the patients were aged 80 or older. The octogenarians had higher rates of stroke (8.0 percent) or major adverse events, which include stroke, heart attack and death, (9.2 percent) either during or immediately after the procedure, compared with younger patients (2.7 percent and 3.4 percent, respectively). In fact, “advanced age was the greatest single risk factor that predicted a major adverse event after carotid artery stenting,” he said.  When followed up to a year after carotid stenting, patients older than 80 continued to have more major adverse outcomes, including stroke. 

Patients with plaque buildup benefit from carotid artery stenting not only because it improves blood flow through the carotid arteries, but also because it prevents plaque debris from breaking off and flowing upstream, where it can block smaller blood vessels within the brain, causing stroke. Recent technological innovations have improved the overall safety of the procedure, including crush-resistant stents that hold the arteries open better than earlier stents did and embolic protection devices that trap plaque debris and blood clots that break off within the vessel during the procedure. However, the findings of this study indicate that even with these improvements, carotid artery stenting continues to pose higher risks of complications for octogenarians than for younger patients, Dr. Stanziale said.