Nikolai Steffenhagen MD, Calgary Stroke Program, University of Calgary, Calgary, AB.
Michael D. Hill, MD, MSc, FRCPC, Calgary Stroke Program, University of Calgary, Calgary, AB.

The majority of strokes occur among the older adult population. Typically, ischemic stroke can be classified by mechanism, and this is the most practical way to think about stroke since it has a direct bearing on the approach to prevention. It is not enough to simply consider that a past stroke implies a need for antiplatelet therapy or anticoagulant therapy without consideration of cause. In this article, we discuss the use of preventive strategies within the context of antithrombotics and according to stroke mechanism.
Key Words: stroke prevention, geriatric, octogenerian, vascular risk factors, carotid stenosis, atrial fibrillation.

Andreas Kastrup, MD, Department of Neurology, Friedrich-Schiller-University of Jena, Jena, Germany.
Klaus Gröschel, MD, Department of Neurology, Friedrich-Schiller-University of Jena, Jena, Germany.

Atherosclerotic carotid artery stenosis is relatively frequent in older patients and is a major cause of disabling stroke or death. Carotid endarterectomy is currently considered the standard of care for all patients with severe symptomatic and asymptomatic carotid stenosis. However, data regarding the efficacy of this treatment in the older patient are limited. In the past few years, carotid angioplasty and stenting have increasingly been used as an alternative to surgery. Although these endovascular techniques have the advantage of avoiding general anesthesia and surgical incisions, preliminary trial data do not support their widespread use in older patients.

Key words: carotid stenosis, carotid endarterectomy, angioplasty, stent, old age.

Claudio S. Cinà, MSc, FRCSC, Associate Clinical Professor, Department of Surgery, Division of Vascular Surgery, McMaster University, Hamilton, ON.
Catherine M. Clase, MSc, FRCPC, Associate Professor, Department of Medicine, Division of Nephrology, McMaster University, Hamilton, ON.

Carotid endarterectomy is effective in preventing strokes in patients with symptomatic carotid stenosis greater than 50%. The magnitude of the benefit is greater with increasing degree of stenosis, male sex, greater number of risk factors for strokes, strokes or hemispheric transient ischemic attacks rather than amaurosis fugax, recurrent events, plaque ulceration, contralateral carotid occlusion and tandem (intracranial and extracranial) stenosis. The effectiveness of carotid endarterectomy, however, is very sensitive to the rate of perioperative events, and centres providing care for these patients need to prospectively monitor their complication rates.
Key words: carotid stenosis, carotid endarterectomy, stroke, transient ischemic attacks.