The Elderly Can Be Candidates for Angioplasty, Stenting
TUESDAY, March 18 -- People over 80 can safely have diagnostic radiology tests and procedures such as artery-opening angioplasty without being hospitalized for their safety, a new study finds.
"The conventional wisdom has been that not only interventional procedures, but also drug trials, might not be safe for people over 80," said Dr. George G. Hartnell, a radiology professor at Tufts University School of Medicine, who was to report the study results Tuesday at the annual meeting of the Society of Interventional Radiology, in Washington, D.C. "The point of our paper was to prove that age by itself was not a risk factor."
Hartnell and his colleagues at Baystate Medical Center in Springfield, Mass., compared the results for such procedures in 64 people 80 and older -- average age 85.1 -- with the same procedures done for 205 people between the ages of 50 and 79.
In the older group, 20 had diagnostic arteriography, an X-ray examination of blood vessels; 20 had angioplasty to open a blocked artery; and 31 had stents placed in arteries. Complications were minimal -- one apparent aneurysm, a weakening of the artery wall that turned out to be nonexistent, and three hematomas that did not require treatment. None of the older people had to be hospitalized.
Complications were about as rare in the younger group, with one hospitalization for a hematoma, an abnormal accumulation of blood, and one for worsening artery blockage.
"My institution several years ago tended to keep these people [over age 80] in the hospital overnight," Hartnell said. "That is much less common now."
Still, he added, "many people are hesitant to do these procedures on the elderly without hospitalization. But hospitals are dangerous places to be. The longer you are in a hospital, the greater the chance that something might happen."
Age alone should not be the deciding factor for a hospital stay for such procedures, said Dr. Curtis W. Bakal, chairman of diagnostic radiology at the Lahey Clinic in Burlington, Mass., and a spokesman for the society. But caution is necessary, he added.
"One has to delve beyond age itself for risk factors, as well as inquiring about someone who will care for these individuals," Bakal said. "I would assume that there is always someone at home to watch after this person."
Bakal said it is necessary to evaluate each person, asking about such issues as heart or kidney problems. "Each patient has to be individually evaluated to see what co-morbidities there might be. Also, before someone leaves, I would want a good idea of how the procedure went so I could make a judgment about sending him home or keeping him in the hospital," he said.
But with all these factors considered, he added, a tendency not to hospitalize "is very believable, and I would think it is right."
A single study can't prove the safety of these procedures for older people, Hartnell acknowledged. "The problem is that the incidence of complications is so low," he said.
You can learn about interventional radiology in general and specific treatments from the Society of Interventional Radiology.
Posted: March 2008
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