Mechanisms of gender-related outcome differences after carotid endarterectomy.
OBJECTIVE
Large randomized trials have confirmed a difference in outcome after carotid endarterectomy (CEA) between men and women. In this review, we aimed to provide an overview of the gender-specific characteristics causing these perioperative and long-term outcome differences between men and women after CEA.


METHODS
A systematic search strategy with the synonyms of 'gender' and 'carotid endarterectomy' was conducted from PubMed and EMBASE databases. Only 11 relevant studies specifically discussing gender-specific related characteristics and their influence on outcome after CEA could be identified.


RESULTS
Due to the limited number of included studies, pooling of findings was impossible, and results are presented in a descriptive manner. Each included study described only one possible gender-specific factor. Differences in carotid artery diameter, sex hormones, sensitivity for antiplatelet therapy, plaque morphology, occurrence of microembolic signals, and restenosis rate have all been suggested as gender-specific characteristics influencing outcome after CEA.


CONCLUSIONS
Higher embolic potential in women and relatively stable female plaque morphology are the best-described factors influencing the difference in outcomes between men and women. However, the overall evidence for outcome differences by gender-specific characteristics in the literature is limited.
den Hartog
Anne G
AG
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Algra
Ale
A
Moll
Frans L
FL
de Borst
Gert J
GJ
D002340:Carotid Artery Diseases / Q000473:pathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors