OBJECTIVE: The aim of the study was to describe the perioperative and long-term results of carotid endarterectomy (CEA) in patients aged 60 or less and compare them to patients of more advanced age in a retrospective single-centre case-control study. METHODS: From January 1996 to December 2014, 5893 consecutive CEAs were performed in our institution. Data concerning these interventions were prospectively inserted in a dedicated database. A retrospective analysis of that database was performed and 457 interventions performed in patients aged 60 or less were found (group 1). The control group was represented by 457 interventions selected from the remaining 5436 by a one-to-one coarsened exact matching on the basis of all the baseline demographic and clinical covariates significantly different in the two groups (group 2). The two groups were compared in terms of intraoperative technical features and perioperative (<30 days) results of interventions (transient ischaemic attack-TIA, stroke and death rates) with χ 2 test. Follow-up data were analysed by life-table analysis (Kaplan-Meier test) in terms of survival, stroke-free and neurological symptom-free survival, freedom from severe restenosis and occlusion and freedom from reintervention, and the results in the two groups were compared by means of log rank test. RESULTS: There were no differences between the two groups in terms of clinical presentation and of degree of carotid stenosis on operated side. Anaesthesiological and surgical details were also similar between the two groups. Thirty-day stroke and death rate was 0.6% in both groups (p = 0.9). Follow-up was available for 877 patients (96% of the study group) with a mean duration of 50 months. Estimated 10-year survival rates were 85% in group 1 (SE 0.03) and 76% in group 2 (SE 0.04, p = 0.003, log rank 8.9). At the same time interval, stroke-free survival was also significantly better in group 1 (85%, SE 0.035) than in group 2 (72.5%, SE 0.03; p = 0.002, log rank 10.1). The corresponding figures in terms of any neurological symptom-free survival were 82.8% in group 1 (SE 0.04) and 70.3% in group 2 (SE 0.04, p = 0.002, log rank 9.7). Estimated freedom from severe restenosis and occlusion was 76.5% in group 1 (SE 0.04) and 88.5% in group 2 (SE 0.035, p = 0.001, log rank 11.9). Disease recurrence was symptomatic in six cases, three in each group. Estimated freedom from reintervention rates at 10 years was 87% in group 1 (SE 0.035) and 91.5% in group 2 (SE 0.03; p = 0.2, log rank 1.1). CONCLUSIONS: CEA in patents aged 60 or less is safe and provides significantly better long-term results than those obtained in patients over 60 in terms of survival and stroke-free survival. Younger patients appear to have higher rates of recurrent carotid stenosis compared to the older cohort; however, these rarely require a secondary intervention.
A Matched Case–Control Study on Early and Late Results of Carotid Endarterectomy Performed in Young Patients
Piffaretti G;
2018-01-01
Abstract
OBJECTIVE: The aim of the study was to describe the perioperative and long-term results of carotid endarterectomy (CEA) in patients aged 60 or less and compare them to patients of more advanced age in a retrospective single-centre case-control study. METHODS: From January 1996 to December 2014, 5893 consecutive CEAs were performed in our institution. Data concerning these interventions were prospectively inserted in a dedicated database. A retrospective analysis of that database was performed and 457 interventions performed in patients aged 60 or less were found (group 1). The control group was represented by 457 interventions selected from the remaining 5436 by a one-to-one coarsened exact matching on the basis of all the baseline demographic and clinical covariates significantly different in the two groups (group 2). The two groups were compared in terms of intraoperative technical features and perioperative (<30 days) results of interventions (transient ischaemic attack-TIA, stroke and death rates) with χ 2 test. Follow-up data were analysed by life-table analysis (Kaplan-Meier test) in terms of survival, stroke-free and neurological symptom-free survival, freedom from severe restenosis and occlusion and freedom from reintervention, and the results in the two groups were compared by means of log rank test. RESULTS: There were no differences between the two groups in terms of clinical presentation and of degree of carotid stenosis on operated side. Anaesthesiological and surgical details were also similar between the two groups. Thirty-day stroke and death rate was 0.6% in both groups (p = 0.9). Follow-up was available for 877 patients (96% of the study group) with a mean duration of 50 months. Estimated 10-year survival rates were 85% in group 1 (SE 0.03) and 76% in group 2 (SE 0.04, p = 0.003, log rank 8.9). At the same time interval, stroke-free survival was also significantly better in group 1 (85%, SE 0.035) than in group 2 (72.5%, SE 0.03; p = 0.002, log rank 10.1). The corresponding figures in terms of any neurological symptom-free survival were 82.8% in group 1 (SE 0.04) and 70.3% in group 2 (SE 0.04, p = 0.002, log rank 9.7). Estimated freedom from severe restenosis and occlusion was 76.5% in group 1 (SE 0.04) and 88.5% in group 2 (SE 0.035, p = 0.001, log rank 11.9). Disease recurrence was symptomatic in six cases, three in each group. Estimated freedom from reintervention rates at 10 years was 87% in group 1 (SE 0.035) and 91.5% in group 2 (SE 0.03; p = 0.2, log rank 1.1). CONCLUSIONS: CEA in patents aged 60 or less is safe and provides significantly better long-term results than those obtained in patients over 60 in terms of survival and stroke-free survival. Younger patients appear to have higher rates of recurrent carotid stenosis compared to the older cohort; however, these rarely require a secondary intervention.
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