Age over 80 years is regarded as a high-risk criterion in the treatment of carotid stenosis (1, 2). There is evidence that carotid endarterectomy (CEA) may be beneficial with lower risk of adverse cerebrovascular events than carotid artery stenting (CAS) in the octogenarian population (3-8). However, the overall goal of this treatment is to extend stroke-free survival combined with patient independence and quality of life. This is closely linked to long-term survival. This study reports national results for long-term survival after carotid endarterectomy in octogenarians in Norway for the 7-year period 2015 - 2021.

We identified all patients undergoing CEA for carotid stenosis between 2015 and 2021 from the national registry. Carotid artery stenting (CAS) is rarely performed in Norway, hence only patients treated with CEA were included. 30-day mortality and long-term survival were calculated based on registry data. Estimates for mean and median survival and survival curves were calculated with Kaplan-Meier analysis. Statistical analysis was performed with SPSS.

We identified 474 patients aged 80 and above treated with CEA in the study period. Only a minority of these patients (n = 13) were treated for asymptomatic stenosis, the remaining 461 patients presented with symptomatic stenosis. In the same period, 2056 patients under the age of 80 years were treated with CEA. Median survival after CEA could not yet be determined in the study groups, but is over 6 years for patients over 80 years and much longer for patients under 80 years, as over 80 % in this group are alive after 6 years of observation. In the subgroup with patients 85 years and older, Kaplan-Meier estimate for median survival after CEA was 1779 days, which equals 4,8 years. Table 1 shows basic patients characteristics. Figure 1 shows survival for patients operated with CEA.

Long-term survival in our study group supports the current policy of treating carotid disease in octogenarians. The figures suggest that there is no overtreatment in this age group at present, as most of the patients will benefit from the operation for many years.

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