Risk, Causes and Prevention of Ischemic Stroke in Elderly Patients with Symptomatic Internal Carotid Artery Stenosis

91 Background. Atherosclerosis is an important cause of stroke in the elderly. Carotid endarterectomy (CE) benefits patients with 70–99% symptomatic internal carotid artery (ICA) stenosis, less for patients with 50–69% stenosis. The benefit of CE in elderly patients (≥75 years) requires evaluation. Methods. Elderly patients with symptomatic ICA stenosis were compared to those 65–74 years and Results. The risk of ipsilateral ischemic stroke was highest in the medically-treated elderly regardless of the degree of stenosis. Among 659 patients with 70–99% stenosis, the absolute risk reduction (ARR) of ipsilateral ischemic stroke by CE was 28.9% for patients ≥75 years (N=71), 15.1% for 65–74 years (N=285) and 9.7% for Conclusions. In the prevention of ipsilateral ischemic stroke, elderly patients with 50–99% symptomatic carotid stenosis benefited more from CE than younger patients. To achieve this benefit, patients must be carefully selected, excluding those with other life threatening illnesses.