title: Carotid endarterectomy in female patients: are the concerns of the Asymptomatic Carotid Atherosclerosis Study valid?
abstract: OBJECTIVE
  Although the results of the Asymptomatic Carotid Atherosclerosis Study clearly demonstrated the benefit of surgical over medical management of severe carotid artery stenosis, the results for women in particular were less certain. This was to some extent because of the higher perioperative complication rate observed in the 281 women (3.6% vs 1.7% in men). The objective of this study was to review a large experience with carotid endarterectomy in female patients and to determine whether the perioperative results differed from those of male patients.
  
  
  METHODS
  A review was conducted of a prospectively compiled database on all carotid endarterectomies performed between 1982 and 1997. Operations performed in 991 female patients were compared with those performed in 1485 male patients.
  
  
  RESULTS
  Female patients had a significantly lower incidence of diabetes, coronary artery disease, and contralateral carotid artery occlusion than did male patients. Female patients had a significantly higher incidence of hypertension. There were no significant differences in the age, smoking history, anesthetic route, shunt use, or clamp tolerance between the two groups. Of 991 female patients, 659 (66.5%) had preoperative symptoms, whereas 332 (33.5%) cases were performed for asymptomatic stenosis. Among 1485 male patients, 1041 (70.1%) had symptoms, and 444 (29.9%) were symptom free before surgery. There were no significant differences noted in the perioperative stroke rates between men and women overall (2.3% vs 2.4%, P =.92), or when divided into symptomatic (2.5% vs 3.0%, P =.52) and asymptomatic (2.0% vs 1.2%, P =.55) cases.
  
  
  CONCLUSIONS
  Carotid endarterectomy can be performed with equally low perioperative stroke rates in men and women in both symptomatic and asymptomatic cases. In this series, symptom-free female patients had the lowest overall stroke rate. The concerns of the Asymptomatic Carotid Atherosclerosis Study regarding the benefit of carotid endarterectomy in female patients should therefore not prevent clinicians from recommending and performing carotid endarterectomy in appropriately selected symptom-free female patients.
authors.affiliation: Division of Vascular Surgery, New York University Medical Center., New York 10016, USA. rockman@university.com
authors.forename: C B
authors.initials: CB
authors.lastname: Rockman
authors.forename: J
authors.initials: J
authors.lastname: Castillo
authors.forename: M A
authors.initials: MA
authors.lastname: Adelman
authors.forename: G R
authors.initials: GR
authors.lastname: Jacobowitz
authors.forename: P J
authors.initials: PJ
authors.lastname: Gagne
authors.forename: P J
authors.initials: PJ
authors.lastname: Lamparello
authors.forename: R
authors.initials: R
authors.lastname: Landis
authors.forename: T S
authors.initials: TS
authors.lastname: Riles
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012737:Sex Factors; D020521:Stroke / Q000209:etiology