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Table of Contents
Vol. 20, No. 2, 2005
Issue release date: July 2005
Section title: Review
Cerebrovasc Dis 2005;20:69–77
(DOI:10.1159/000086509)

A Systematic Review of the Associations between Age and Sex and the Operative Risks of Carotid Endarterectomy

Bond R.a · Rerkasem K.b · Cuffe R.a · Rothwell P.M.a
aStroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK; bDepartment of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

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Article / Publication Details

First-Page Preview
Abstract of Review

Received: January 24, 2005
Accepted: April 08, 2005
Published online: July 29, 2005
Issue release date: July 2005

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 0

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: Randomized trials of carotid endarterectomy (CEA) for both symptomatic and asymptomatic carotid stenosis have demonstrated that benefit is decreased in women, due partly to a high operative risk, which is independent of age. However, it is uncertain whether these trial-based observations are generalisable to routine clinical practice. Methods: We performed a systematic review of all publications reporting data on the association between age and/or sex and procedural risk of stroke and/or death following CEA from 1980 to 2004. Results: 62 eligible papers reported relevant data. Females had a higher rate of operative stroke and death (25 studies, OR = 1.31, 95% CI = 1.17–1.47, p < 0.001) than males, but no increase in operative mortality (15 studies, OR = 1.05, 95% CI = 0.81–0.86, p = 0.78). Compared with younger patients, operative mortality was increased at ≧75 years (20 studies, OR = 1.36, 95% CI = 1.07–1.68, p = 0.02), at age ≧80 years (15 studies, OR = 1.80, 95% CI = 1.26–2.45, p < 0.001) and in older patients overall (35 studies, OR = 1.50, 95% CI = 1.26–1.78, p < 0.001). In contrast, risk of non-fatal stroke did not increase with age and so the combined perioperative risk was only slightly increased at age ≧75 years (21 studies, OR = 1.18, 95% CI = 0.94–1.44, p = 0.06), at age ≧80 years (10 studies, OR = 1.14, 95% CI = 0.92–1.36, p = 0.34) and in older patients overall (36 studies, OR = 1.17, 95% CI = 1.04–1.31, p = 0.01). Conclusions: The effects of age and sex on the operative risk of CEA in published case series are consistent with those observed in the trials. Operative risk of stroke is increased in women and operative mortality is increased in patients aged ≧75 years.

© 2005 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Review

Received: January 24, 2005
Accepted: April 08, 2005
Published online: July 29, 2005
Issue release date: July 2005

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 0

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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