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. 2021 Mar 8:8:646204.
doi: 10.3389/fsurg.2021.646204. eCollection 2021.

Early and Long-Term Outcomes of Carotid Stenting and Carotid Endarterectomy in Women

Edoardo Pasqui  1 , Gianmarco de Donato  1 , Giuseppe Alba  1 , Brenda Brancaccio  1 , Claudia Panzano  1 , Alessandro Cappelli  1 , Carlo Setacci  1 , Giancarlo Palasciano  1
Affiliations

Early and Long-Term Outcomes of Carotid Stenting and Carotid Endarterectomy in Women

Edoardo Pasqui et al. Front Surg. .

Abstract

Background: The role of carotid revascularization in women remains intensely debated because of the lower benefit and higher perioperative risks concerning the male counterpart. Carotid artery endarterectomy (CEA) and stenting (CAS) represent the two most valuable stroke prevention techniques due to large vessel disease. This study investigates the early and late outcomes in female sex in a real-world everyday clinical practice. Methods: Data were retrospectively analyzed from a single-center database prospectively compiled. A total of 234 procedures, both symptomatic and asymptomatic, were identified (98 CEAs and 136 CASs). Perioperative risks of death, cerebral ischemic events, and local complications were analyzed and compared between the two groups. Long-term outcomes were evaluated in overall survival, freedom from ipsilateral stroke/transient ischemic attack, and freedom from restenosis (>50%) and reintervention. Results: Women who underwent CAS and CEA did not differ in perioperative ischemic cerebral events (2.2 vs. 0%, p = 0.26) and death (0.8 vs. 0%, p = 1). Other perioperative and 30-day outcomes were similarly distributed within the two groups. Kaplan-Meier curves between CAS and CEA groups highlighted no statistical differences at 6 years in overall survival (77.4 vs. 77.1%, p = 0.47) of ipsilateral stroke/transient ischemic attack (94.1 vs. 92.9%, p = 0.9). Conversely, significant differences were showed in 6 years freedom from restenosis (93.1 vs. 83.3%, p = 0.03) and reinterventions (97.7 vs. 87.8%, p = 0.015). Conclusion: Our results revealed that both CEA and CAS have acceptable perioperative risk in women. Long-term outcomes highlighted favorable indications for both procedures, especially for CAS, which seemed to be an excellent alternative to CEA in female patients when performed by well-trained operators.

Keywords: carotid disease; carotid endarterectomy; carotid stenting; stroke; women.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves representing overall survival rates in CAS and CEA groups.
Figure 2
Figure 2
Kaplan–Meier curves representing freedom from Ipsilateral Stroke/TIA in CAS and CEA groups.
Figure 3
Figure 3
Kaplan–Meier curves representing freedom from restenosis in CAS and CEA groups.
Figure 4
Figure 4
Kaplan–Meier curves representing freedom from reinterventions in CAS and CEA groups.
See this image and copyright information in PMC

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