Is surgery always the best treatment for severe carotid stenosis in the frail elderly?

OBJECTIVES: Presentation of a case of carotid stenosis in an elderly patient with multiple co-morbidities, and its management.

METHODS: Pre-operative management of an elderly patient affected by carotid artery stenosis with cardiac, metabolic and renal comorbidities and a recent history of buccal squamous carcinoma.

RESULTS: Pre-operative anestesiologic assessment showed an increased risk for the presence of heart failure, cardiogenic pulmonary hypertension, mild/moderate stage renal disease.

CONCLUSION: The frail elderly represents a real challenge for the surgeon, because in choosing treatment other options must be taken into account both in view of local disease and of various systemic comorbidities.