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Researchers find possible cause for high stroke rate in elderly after carotid stenting
van Lammeren G. Stroke. 2011;doi:10.1161/strokeaha.110.607382.
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Vulnerable plaque may be an important underlying cause for the increased risk for stroke observed in elderly patients who undergo carotid artery stenting, according to a new analysis.
Specifically, the study, appearing in the journal Stroke, found that plaque stability gradually declines with age and that older patients have relatively unstable plaques.
“The current study shows that the effect of age on carotid plaque stability is rather a gliding scale than an exponential change of plaque composition at a certain age point, like 80 years,” the researchers wrote. “This is in line with results from randomized trials showing that the periprocedural risk for carotid artery stenting increases gradually with age.”
In the study, the Netherlands-based researchers harvested carotid atherosclerotic plaques from consecutive patients (n=1,385) who underwent carotid endarterectomy from 2002 to 2010. The plaques were subjected to histological examination and the patients were separated into four age-dependent groups: younger than 60 years (n=262), 60 to 69 years (n=485), 70 to 79 years (n=504) and at least 80 years of age (n=134).
According to results, increasing age correlated with a decline in smooth muscle cells in the carotid plaque. The elderly were also more likely to have plaques with large atheroma and heavy plaque calcifications.
In addition, after adjustment for baseline characteristics, age was independently associated with more vulnerable carotid plaque composition.
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