Advanced Age a Key Factor in Survival and Stroke
after Carotid-Artery Surgery
Study seems to counter another released last month
saying even those age 80 or older should be considered for the surgery
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 Dr. Ethan Halm helped
identify factors that can affect whether a patient dies or
suffers a stroke after carotid-artery surgery. Photo: UT
Southwestern Medical Center |
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Nov. 6, 2008 Advanced age and race are among the
factors that can affect whether a patient dies or suffers a stroke after
carotid-artery surgery, a UT Southwestern physician involved in a
multicenter study has found.
The procedure, one of the most common types
of vascular surgeries, involves opening the carotid artery in the neck
and removing harmful plaque to restore blood flow to the brain.
"This study identified 11 readily available,
clinical risk factors that can help referring physicians, neurologists,
surgeons and anesthesiologists better weigh the risks and benefits of
carotid surgery for an individual patient," said Dr. Ethan Halm, new
chief of the William T. and Gay F. Solomon Division of General Internal
Medicine at UT Southwestern and the study's lead author.
"You don't want to cause a stroke to prevent a
stroke."
The new findings appear in the current online
version of the journal Stroke.
These findings seem to counter another study released last
month that found the procedure -
carotid endarterectomy - should not be considered unsafe for older
people - even those age 80 and older. (See link to story in sidebar on
left.)
Dr. Halm and colleagues used data from the New York
Carotid Artery Surgery (NYCAS) study, which evaluated the outcomes of
9,308 carotid surgeries performed on elderly patients by 482 surgeons in
167 hospitals in New York state.
It is the largest study of its kind to use
clinically detailed data on a population-based study of carotid-surgery
outcomes and risk factors in community practice. Dr. Halm recently left
Mt. Sinai School of Medicine in New York to lead UT Southwestern's
general internal medicine division.
Carotid-artery surgery, one of the most common
types of vascular surgeries performed in the U.S., involves opening the
carotid artery in the neck and removing harmful plaque to restore blood
flow to the brain.
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About Carotid Artery Disease
 Your
carotid arteries are two large blood vessels in your neck. They
supply your brain with blood. If you have carotid artery
disease, the arteries become narrow, usually from the buildup of
cholesterol and other material. If a blood clot sticks in
the narrowed arteries, blood can't reach your brain. This is one
of the causes of
stroke.
Carotid
artery disease often does not cause symptoms, but there are
tests that can tell your doctor if you have it. If the arteries
are very narrow, you may need an operation called an
endarterectomy to remove the plaque. For less severe narrowing,
a medicine to prevent blood clots can reduce your risk of
stroke. Another option for people who can't have surgery is
carotid angioplasty. This involves placing balloons and/or
stents into the artery to open it and hold it open.
More
information
Carotid Artery Disease (American Heart Association)
Carotid Artery Disease (National Heart, Lung, and Blood
Institute)
Questions and Answers about Carotid Endarterectomy (National
Institute of Neurological Disorders and Stroke)
Source:
MedlinePlus |
Although previous controlled trials have shown
carotid surgery reduces the long-term risk of death or stroke in some
patients, there is a chance the procedure could cause death or stroke.
The NYCAS study found that the overall risk of
death or stroke in the first 30 days after surgery varied greatly
according to a patient's age, race, number of serious medical
conditions, severity of carotid disease and acuity of neurological
symptoms.
The statistical findings included:
● Advanced age (defined in the NYCAS study as
80 years or older) increased the risk-adjusted odds of death or stroke
by 30 percent;
● Non-white patients were 83 percent more
likely to have a negative outcome within 30 days;
● Having coronary artery disease increased the
odds of death or stroke by 51 percent; and
● Having diabetes treated with insulin
increased the odds of death or stroke by 55 percent.
In addition, the more serious the neurological
symptoms a patient had from the blockage of the carotid artery, the
higher the risk of negative outcomes.
Patients who suffered a stroke or temporary stroke
in the year before carotid surgery also had increased risks.
"Having one risk factor would not necessarily be a
reason not to have the surgery, but having multiple risk factors, like
being over the age of 80 with heart disease and diabetes, might tip the
balance for many patients in favor of medical management," Dr. Halm
said.
Background Information
The NYCAS study was supported by the Agency for
Healthcare Research and Quality, Centers for Medicare & Medicaid
Services, the Robert Wood Johnson Foundation and the National Institute
of Neurological Disorders and Stroke.
Visit
http://www.utsouthwestern.org/surgery to learn more about clinical
services in surgery at UT Southwestern.
