Examination of sex as an independent risk factor for adverse events after carotid endarterectomy

Abstract

Logistic regression analysis of comorbidities and hospital setting indicated that female sex is not independently associated with higher mortality or a higher stroke rate during CEA. These data indicate that patients with carotid stenosis frequently have multiple medical problems that need to be carefully examined and controlled before any single patient or hospital factor is designated as significantly related to adverse outcomes.

Outcome of carotid artery interventions among female patients, 2004 to 2005

“…In particular, asymptomatic women were at greater risk for a perioperative event than asymptomatic men. Harthun et al 22 also noted a slight increase in perioperative strokes in women than in men; however, in their logistic regression analysis, female sex was not independently associated with a higher stroke or mortality rate. Importantly, when historical rates of stroke in medically managed female patients were used for comparison, in neither of these two studies were the procedural stroke rates with CEA considered to be high enough to warrant solely medical management of the female cohort.…”

Gender-related risk factors for perioperative stroke after carotid endarterectomy in symptomatic patients

“…2,8 The poorer surgical outcomes of endarterectomy in women are contributed to several factors, like vessel diameter, sensitivity to antiplatelet therapy, sex hormones, plaque composition and morphology, emboli, and restenosis rate. [9][10][11] The recently-published CREST (Carotid Revascularization Endarterectomy vs Stenting Trial) results showed that CEA is associated with similar rates of periprocedural stroke in women and men. 12 Some research has also confirmed that female sex is not independently associated with higher mortality or a higher stroke rate during CEA.…”

Gender-based outcomes after eversion carotid endarterectomy from 1998 to 2009

“…[8][9][10][11][12][13][14][15] Other investigators have found CEA just as safe and beneficial in women as in men, challenging the findings of the RCTs. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Why women should be at greater perioperative risk than men remains to be explained. Meanwhile, the controversial findings available to date clearly influence medical practice, although they are far from providing an exhaustive answer to the question of whether female gender is a risk factor for adverse events during CEA.…”