Dorigo W, et al. - This study was designed to delineate 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. In patients aged 60 or less, CEA proved safe and provided significantly better long-term results than those obtained in patients over 60 in terms of survival and stroke-free survival. Compared to the older cohort, younger patients seemed to have higher rates of recurrent carotid stenosis; however, these required a secondary intervention rarely.

Methods

• Researchers identified 5,893 consecutive CEAs that were performed in their institution from January 1996 to December 2014.
• They prospectively inserted data concerning these interventions in a dedicated database.
• A retrospective analysis was performed of that database; 457 interventions performed in patients aged 60 or less were identified (group 1).
• The control group comprised of 457 interventions selected from the remaining 5,436 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).
• In terms of intraoperative technical features and perioperative (<30 days) results of interventions, the two groups were compared (transient ischaemic attack-TIA, stroke and death rates) with X² test.
• Life-table analysis (Kaplan–Meier test) was used to analyze the follow-up data in terms of survival, stroke-free and neurological symptom-free survival, freedom from severe restenosis and occlusion and freedom from reintervention.
• The results in the two groups were compared by means of log rank test.

Results

• The two groups were similar regarding clinical presentation and degree of carotid stenosis on operated side.
• Similar anaesthesiological and surgical details were reported between the two groups.
• Both groups indicated 30-day stroke and death rate of 0.6% (p=0.9).
• For 877 patients (96% of the study group), follow-up (a mean duration of 50 months) was available.
• In group 1 and group 2, estimated 10-year survival rates were 85% (SE 0.03) and 76% (SE 0.04, p=0.003, log rank 8.9), respectively.
• At the same time interval, group 1 also indicated stroke-free survival significantly better (85%, SE 0.035) than group 2 (72.5%, SE 0.03; p=0.002, log rank 10.1).
• In terms of any neurological symptom-free survival, the corresponding figures 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).
• Six cases indicated symptomatic disease recurrence, three in each group.
• At 10 years, group 1 indicated estimated freedom from reintervention rates of 87% (SE 0.035) compared to 91.5% in group 2 (SE 0.03; p=0.2, log rank 1.1).