Randomized trials (RCT) of carotid endarterectomy (CEA) demonstrated little benefit from surgery in women because of high operative risk. Whether these findings are also applicable to carotid artery stenting (CAS) remains subject of investigation. Our aim was to determine whether gender differences exist in the risk of perioperative complications related to CAS.
Methods
Data from a single-center carotid surgery database, including 1087 CAS (312 women; 775 men) and 1109 CEA (319 women;790 men), in unselected population, were analyzed. Perioperative risks of death, stroke, and local complications in men and women undergoing CAS and CEA were compared.
Results
The perioperative risks of stroke or death were not statistically different in CAS women compared to CAS men (2.2% vs 3.1%; odds ratio [OR]=0.3; 95% CI: 0.56-3.1; p=0.54) either symptomatic or not. However, CAS women were more prone to experience minor local complications (1.6% vs 0.9%) and less likely to have a disabling stroke (0.6% vs 1.4%) or TIA (2.8% vs 3.2%) and cardiac complication (0% vs 0.4%) with respect to men. Conversely, in the CEA cohort, the perioperative risk of death and stroke was, although non statistically, higher in women than in men (2.8% vs 1.4%, p =0.2), and the stroke risk was particularly higher in asymptomatic women [2.9% vs 0.6%; OR: 4.6, CI: 1.2-23.0, p=0.02)]. The risk of stroke or death in CAS and CEA women were similar (p=0.4).
Conclusions
Women and men with carotid stenosis have similar early favourable outcome from CAS in experienced centers. CAS should not be discouraged as a primary choice for treatment of carotid stenosis in women. Results from large RCTs are awaited to prove if CAS, will truly benefit women for carotid revascularization.
Any stroke and death in women
Any stroke and death in men
p
CAS (all patients)
7/312(2.2%)
24/775(3.1%)
0.54
CAS for symptomatic
3/65(4.6%)
9/203(4.4%)
1
CAS for asymptomatic
4/247(1.6%)
14/572(2.4%)
0.6
CEA (all patients)
9/319(2.8%)
12/790(1.5%)
0.2
CEA for symptomatic
3/105(2.9%)
9/308(2.9%)
1
CEA for asymptomatic
6/214(2.8%)
3/482(0.6%)
0.02
Vascular and Endovascular Surgery Unit,University of Perugia, Perugia, Italy
Author Disclosures: P. De Rango, None; G. Parlani, None; F. Verzini, None; E. Cieri, None; G. Giordano, None; P. Cao, None.
FULL TEXT
