L'âge est-il un facteur limitant pour la chirurgie carotidienne?

To evaluate the role of carotid surgery in elderly patients 75 years and older, we reviewed 912 carotid endarterectomies performed on 806 patients between 1987 and 1990. There were 151 patients (19% of the whole series) aged 75 years and older (160 endarterectomies, group A), including 29 octogenarians, vs 655 patients under 75 years of age (group B). There were more women in the elderly age group (44%) than in the younger one (38%). Symptoms, risk factors, operative outcome and follow up data of the two groups were compared. The risk profile was similar for the two age groups, with exception for coronary heart disease, less frequent in the older patient group (25% had previous infarction vs 44%). Indication for carotid endarterectomy was different in the two age groups: 41% of group A underwent prophylactic thrombendarterectomy for high degree stenosis, while only 30% of group B had asymptomatic carotid disease. In group A, 6% of the patients had carotid endarterectomy after recovering from a mild stroke, vs 2% in group B. Angiography revealed bilateral carotid disease in 59% of the group A patients (including 15% with contralateral occlusion) vs 40% in group B. Operative mortality was 1.5% for the younger age group vs 2.5% for the older age group. The cause of death was cardiac in 60%. A follow up is available for all patients who benefited carotid endarterectomy since 1976, including 180 patients aged 75 years or older.(ABSTRACT TRUNCATED AT 250 WORDS)