Thirty-Day Stroke and Mortality After Carotid Revascularization Among Octogenarians with Symptomatic Carotid Stenosis: Real-World Evidence from a National Surgical Quality Registry

Abstract

Background: The outcomes of carotid revascularization among octogenarians are not well studied. We present analyses of 30-day stroke and mortality of patients aged ≥80 years using real-world data from a national surgical quality registry. Methods: The National Surgical Quality Improvement Program targeted data set for carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) was queried for patients aged ≥80 years undergoing CEA and CAS between 2012 and 2019. Results: A total of 122 and 3013 patients aged ≥80 years with symptomatic carotid stenosis undergoing CAS and CEA, respectively, were identified. Patients with CAS were more likely to be older than 90 years (P = 0.006) and have diabetes (P = 0.036), were more likely to have high-risk anatomy (P < 0.001), but had lower American Society of Anesthesiologists score (P < 0.001). An ipsilateral stroke had been experienced by 43.6% of patients with CAS and 44.7% of patients with CEA. The rate of 30-day composite outcome was 6.4% in the CAS group and 4.5% in the CEA group (P = 0.326). The f 30-day mortality was significantly higher for CAS (5.6% vs. 1.7%, P = 0.001); however, the difference between the cohorts was not significant (CAS, 2.4% vs. CEA, 3.4%, P = 0.555). On multivariable analysis, CEA was associated with significantly lower odds of mortality (odds ratio [OR], 0.32; P = 0.0145). Symptom presentation other than ipsilateral stroke was associated with significantly decreased odds of 30-day outcome (amaurosis fugax/transient monocular blindness, OR, 0.39, P = 0.004; transient ischemic attack, OR, 0.57, P = 0.003), whereas higher age had significantly increased odds (OR, 1.95; P = 0.0172). Conclusions: Real-world analyses from a surgical quality registry show that CEA may be associated with lower odds of mortality compared with CAS among octogenarians.