Carotis-Chirurgie beim 80-jährigen oder älteren Patienten

Grundproblematik und Fragestellung:uf Grund des hohen Alters und einer deutlich erhöhten Co-Morbidität wird von internistisch-geriatrischer Seite die Indikation zur Carotis-Thrombendarteriektomie (TEA) beim ≥ 80-jährigen Patienten häufig mit Zurückhaltung gesehen. Gerade der alte Mensch ist jedoch einem exponentiell ansteigenden Risiko eines ischämischen Apoplexes ausgesetzt. Es erhebt sich demnach die Frage nach der Morbidität und Letalität der Carotisdesobliteration beim alten Menschen.

Patienten und Methodik: Zwischen 1994 und 1998 wurden 46 von 912 Carotisdesobliterationen bei ≥ 80-jährigen Patienten (15 Frauen, 31 Männer) vorgenommen. Prospektiv wurden in einer Datenbank Indikationen, Diagnostik sowie Begleiterkrankungen und perioperative Komplikationen der Carotis-TEA erfasst.

Ergebnisse: Die perioperative Apoplex-Rate betrug 2,2 %, die Letalität 0 %. Drei Patienten (6,5 %) erlitten ein passageres neurologisches Defizit. Eine Patientin musste auf Grund einer postoperativen Carotisthrombose notfallmäßig reoperiert werden. Bei einem Patienten (2,2 %) kam es intraoperativ zu einer Asystolie bei hypersensitivem Carotissinus, sonstige schwere kardiopulmonale Komplikationen wurden nicht beobachtet. Bei einem weiteren Patienten (2,2 %) kam es durch Hakenzug zu einer Mundastschwäche des Nervus facialis.

Folgerung: Die Ergebnisse weisen darauf hin, dass auch beim ≥ 80-jährigen Patienten eine Carotis-TEA mit großer Sicherheit durchgeführt werden kann.

Carotid artery surgery in patients 80 years or older

Background and objective: Because of their high age and markedly increased co-morbidity, physicians and geriatricians are often cautious in their indications for carotid thrombarterectomy (TEA) in patients 80 years or older. However, it is these very patients who are subject to an exponentially increased risk of ischaemic cerabral vascular accidents (CVA). This study examined the morbidity and mortality rates of TEA in patients of this age group at one institution.

Patients and methods: Between 1994 and 1998, among a total of 912 TEAs, 46 had been performed in patients 80 years or older (15 women, 31 men): indications, diagnosis and associated diseases as well as perioperative complications were entered prospectively into a data-bank.

Results: Only one patient (2.2%) sustained a perioperative CVA and no patient died. Three patients (6.5%) developed transitory neurological deficits. One patient had to have an emergency reoperation because of a postoperative carotid artery thrombosis. One patient had an intraoperative asystole due to a hypersensitive carotid sinus. There were no other serious cardiovascular or pulmonary complications. One patient sustained some oral muscle weakness as a result of intraoperative retractor pull on a branch of the facial muscle.

Conclusion: These results indicate that even in patients of this age group carotid TEA can be performed with great safety.

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