Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 5;14(8):830.
doi: 10.3390/jpm14080830.

Sex as a Predictor of Outcomes for Symptomatic Carotid Stenosis: A Comparative Analysis between CAS and CEA

Pasqualino Sirignano  1 , Costanza Margheritini  2 , Wassim Mansour  3 , Francesco Aloisi  2 , Carlo Setacci  4 , Francesco Speziale  3 , Eugenio Stabile  5 , Maurizio Taurino  2 , On Behalf Of The Ironguard-Study Investigators
Affiliations

Sex as a Predictor of Outcomes for Symptomatic Carotid Stenosis: A Comparative Analysis between CAS and CEA

Pasqualino Sirignano et al. J Pers Med. .

Abstract

Purpose: Reporting gender-related outcomes for symptomatic carotid lesion revascularization after both endarterectomy (CEA) and carotid artery stenting (CAS) procedures in an unselected group of patients treated by Italian Vascular Specialists.

Material and methods: A retrospective study was conducted on patients presenting with recently symptomatic carotid stenosis treated by CAS and by CEA. The primary endpoint was the 30 days any stroke occurrence rate; secondary endpoints were technical success, occurrence of transient ischemic attack (TIA), acute myocardial infarction (AMI) and death. Demographic, clinical and procedural data were all noted in order to identify the outcome's determining factor.

Results: A total of 265 patients (193 males and 72 females) were enrolled, and of these 134 (50.5%) underwent CEA and 131 CAS (49.5%). At 30 days, the overall new stroke rate was 3.4% (one fatal), and no TIA, AMI or deaths were observed. Among strokes, seven major and two minor strokes were reported, with six after CEA and three after CAS (p = 0.32; OR: 2; CI95%: 0.48-8.17). The timing of revascularization has been found to be slightly associated with new stroke occurrence: seven out nine strokes were observed in patients treated within 14 days from symptom onset (5.5% vs. 1.4%; p = 0.08, OR: 3.8, CI95%: 0.77-18.56). Lastly, female patients presented a significantly higher risk of post-operative stroke compared to male patients: 6.9% vs. 2.1% (p: 0.05; OR: 3.52; CI95%: 0.91-13.52).

Conclusions: Our experience seems to suggest that both CEA and CAS provide safe and effective results in treating patients presenting with symptomatic carotid stenosis. Regardless of the type of revascularization, female sex is an independent risk factor for stroke recurrence after treatment.

Keywords: carotid artery stenting; carotid endarterectomy; carotid revascularization; female sex; symptomatic carotid stenosis; timing.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Similar articles

See all similar articles

References

    1. Mauvais-Jarvis F., Bairey Merz N., Barnes P.J., Brinton R.D., Carrero J.J., DeMeo D.L., De Vries G.J., Epperson C.N., Govindan R., Klein S.L., et al. Sex and gender: Modifiers of health, disease, and medicine. Lancet. 2020;396:565–582. doi: 10.1016/S0140-6736(20)31561-0. - DOI - PMC - PubMed
    1. Pelletier R., Ditto B., Pilote L. A composite measure of gender and its association with risk factors in patients with premature acute coronary syndrome. Psychosom. Med. 2015;77:517–526. doi: 10.1097/PSY.0000000000000186. - DOI - PubMed
    1. Tobb K., Kocher M., Bullock-Palmer R.P. Underrepresentation of women in cardiovascular trials- it is time to shatter this glass ceiling. Am. Heart J. Plus. 2022;13:100–109. doi: 10.1016/j.ahjo.2022.100109. - DOI - PMC - PubMed
    1. Howard V.J., Algra A., Howard G., Bonati L.H., de Borst G.J., Bulbulia R., Calvet D., Eckstein H.-H., Fraedrich G., Greving J.P., et al. Carotid Stenosis Trialists’ Collaboration. Absence of Consistent Sex Differences in Outcomes from Symptomatic Carotid Endarterectomy and Stenting Randomized Trials. Stroke. 2021;52:416–423. doi: 10.1161/STROKEAHA.120.030184. - DOI - PMC - PubMed
    1. Howard V.J., Lutsep H.L., Mackey A., Demaerschalk B.M., Sam A.D., 2nd, Gonzales N.R., Sheffet A.J., Voeks J.H., Meschia J.F., CREST Investigators et al. Influence of sex on outcomes of stenting versus endarterectomy: A subgroup analysis of the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) Lancet Neurol. 2011;10:530–537. doi: 10.1016/S1474-4422(11)70080-1. - DOI - PMC - PubMed

LinkOut - more resources