ABSTRACT
Benefit from CEA increased with age in the pooled analysis of trials in patients with recently symptomatic stenosis, particularly in patients aged 75 years (Fig. 4). Although patients randomized in trials generally have a good prognosis (32), and there is some evidence of an increased operative mortality in elderly patients in routine clinical practice, particularly in those aged 85 years (33), a recent systematic review of all published surgical caseseries reported no increase in the operative risk of stroke and death in older age groups (34). There is therefore no justification for withholding CEA in patients aged 75 years who are deemed to be medically fit to undergo surgery. The evidence suggests that benefit is likely to be greatest in this group because of their high risk of stroke on medical treatment. However, it is important to understand that it does take a year for overall benefit from surgery to accrue in patients with >70% stenosis and over 2 years in patients with 50-69% stenosis, and so elderly patients who are considered for surgery should ideally have a life expectancy that goes beyond these periods.
