The safety of CAS in elderly patients remains controversial. And the aims of this study were to evaluate 30-day outcomes after CAS in elderly patients (≥70 years) and to investigate the risk factors for the postoperative incidence of major adverse clinical events (MACEs) for providing clinical evidence to improve CAS safety in this specific subgroup of patients.
Our data set included patients who underwent CAS between 2001 and 2017 at Xuanwu Hospital, Capital Medical University. The primary outcome variable was 30-day postoperative incidence of MACEs: death, myocardial infarction (MI), and ipsilateral stroke. Univariable and multivariable analyses were performed to identify high-risk patients and procedural characteristics associated with MACEs.
A total of 1029 elderly patients who underwent CAS for carotid artery stenosis were identified and analyzed. The incidence of postoperative MACEs was 3.01% (31 cases: 5 deaths, 24 strokes, and 2 MIs) for these patients. After multivariable analysis, the independent predictors of MACEs included a family history of stroke, (odds ratio [OR]=3.817; 95% confidence interval [CI]=1.227-11.876; P=0.021), symptoms (OR=2.650; 95% CI=1.210-5.806; P=0.015), and modified Rankin Scale (mRS) ≥3 (OR=4.594; 95% CI=1.708-12.352; P=0.003). Hyperlipidemia was not an independent risk factor (OR=1.597; 95% CI=0.745-3.425; P=0.229).
According to our single-center experience, CAS was safely performed in elderly patients. Being symptomatic, having a family history of stroke, and presence of a neurological deficit (mRS ≥3) increased the risk of 30-day postoperative MACEs.

Copyright © 2020. Published by Elsevier Inc.