Surgical treatment of advanced age patients with bilateral carotid artery disease

Objective. To analyze the effectiveness of surgical treatment in elderly patients with bilateral atherosclerotic lesions of carotid arteries. Material and methods. Carotid endarterectomy was performed in 91 patients aged 75—90 years (62 men, 29 women; mean age 78±2 years) with bilateral carotid artery disease and chronic cerebrovascular insufficiency (CVI) grades I-IV. Patients were divided into two groups: group I (n=54) — bilateral internal carotid artery (ICA) stenosis 69—99%; group II (n=37) — combination of ICA stenosis with occlusion of contralateral carotid artery. Results. Elderly patients with severe carotid artery stenosis differed significantly in incidence of open circle of Willis (22% in group 1 and 73% in group 2, p<0.001), CVI grade IV (28% and 84%, p<0.001) and incidence of temporary intraluminal shunting (13% in group 1 versus 51% in group 2, p<0.001). The overall incidence of perioperative complications did not differ significantly between groups: 7 (19%) events in group 2 versus 5 (9%) events in group 1 (p=0.216; OR=2.29, 95% CI 0.67—7.86). Conclusion. Contralateral ICA occlusion is an independent factor in progression of cerebral ischemic deficit and higher perioperative risk. Integration of Plaque-RADS atherosclerotic plaque instability criteria into the algorithm for determining surgical reconstruction allows for optimization of strategy for bilateral carotid artery disease.