Gender-specific 30-day outcomes after carotid endarterectomy and carotid artery stenting in the Society for Vascular Surgery Vascular Registry.
OBJECTIVE
Although the optimal treatment of carotid stenosis remains unclear, available data suggest that women have higher risk of adverse events after carotid revascularization. We used data from the Society for Vascular Surgery Vascular Registry to determine the effect of gender on outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS).


METHODS
There were 9865 patients (40.6% women) who underwent CEA (n = 6492) and CAS (n = 3373). The primary end point was a composite of death, stroke, and myocardial infarction at 30 days.


RESULTS
There was no difference in age and ethnicity between genders, but men were more likely to be symptomatic (41.6% vs 38.6%; P < .003). There was a higher prevalence of hypertension and chronic obstructive pulmonary disease in women, whereas men had a higher prevalence of coronary artery disease, history of myocardial infarction, and smoking history. For disease etiology in CAS, restenosis was more common in women (28.7% vs 19.7%; P < .0001), and radiation was higher in men (6.2% vs 2.6%; P < .0001). Comparing by gender, there were no statistically significant differences in the primary end point for CEA (women, 4.07%; men, 4.06%) or CAS (women, 6.69%; men, 6.80%). There remains no difference after stratification by symptomatology and multivariate risk adjustment.


CONCLUSIONS
In this large, real-world analysis, women and men demonstrated similar results after CEA or CAS. These data suggest that, contrary to previous reports, women do not have a higher risk of adverse events after carotid revascularization.
Section of Vascular Surgery, Washington University School of Medicine, St. Louis, Mo.
Jeffrey
J
Jim
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Ellen D
ED
Dillavou
Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va.
Gilbert R
GR
Upchurch
Section of Vascular Surgery, University of Michigan School of Medicine, Ann Arbor, Mich.
Nicholas H
NH
Osborne
New England Research Institutes Inc, Watertown, Mass.
Christopher T
CT
Kenwood
New England Research Institutes Inc, Watertown, Mass. Electronic address: ssiami@neriscience.com.
Flora S
FS
Siami
Division of Vascular Surgery, Harbor-UCLA Medical Center, Los Angeles, Calif.
Rodney A
RA
White
Northside Heart and Vascular Institute, Atlanta, Ga.
Joseph J
JJ
Ricotta
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult