Early and late outcomes of young patients after carotid endarterectomy

Background and purpose. Carotid atherosclerotic disease in young adults is uncommon but may be more virulent and diffuse than in alder patients. Although few studies have well established that carotid endarterectomy (CEA) is of benefit for high-grade asymptomatic lesions and for moderate- and high-grade symptomatic lesions, the safety and durability of CEA in the young remain controversial. The aim of this study was to compare CEA outcome in young people with outcome in an older control group. Methods. Thirty-five patients up to 50 years old (mean 46.5 +/- 0.5 years) and undergoing 42 CEAs were compared with a randomly selected group of 50 patients more than 60 years old (mean 68.7 +/- 0.4 years) and undergoing 55 CEAs during the same period. Data were obtained on demographics, atherosclerotic risk factors, indications for surgery, perioperative outcome, recurrent stenosis and symptoms, late stroke, and survival. Results. Smoking (P <. 001), alcohol consumption (P <.001), and lower levels of high-density lipoprotein cholesterol (P = .02) were more prevalent in the young patients, who were also more likely to be symptomatic at presentation (P = .001) with a higher incidence of stroke (P = .01) and contralateral carotid occlusion (P = .04). The perioperative stroke risk and mortality rates were nil for the young group. During a mean follow-up of 47 +/- 40 months, there were no significant differences between the 2 groups in survival, symptom recurrence, stenosis recurrence, and reoperation rates. Young patients had a higher incidence of contralateral disease requiring surgery (P =. 04). Conclusions. These findings show that CEA may be performed in young adults with an excellent perioperative outcome; recurrence, late stroke, and survival rates do not differ significant from those observed among their older counterparts.