Mechanisms of gender-related outcome differences after carotid endarterectomy

Hartog, A.G. den; Algra, Ale; Moll, Frans L.; Borst, Gert J. de

doi:10.1016/j.jvs.2010.03.068

Cited by 41 publications

(30 citation statements)

References 77 publications

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“…Greater diameters among men were expected and confirmed 23,24 . The length of stay in the hospital was shorter in men compared to women 12 .…”

Section: Discussionsupporting

confidence: 60%

Mapeamento ecográfico da bifurcação das artérias carótidas extracranianas para planejamento cirúrgico: diferenças baseadas no gênero do paciente

Pontes¹,

Barros²,

Roelke³

et al. 2011

J. vasc. bras.

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Context: Doppler ultrasonography is an established method for diagnosis, preoperative imaging and follow-up of extracranial carotid artery disease. Objetive: The evaluation of gender differences in carotid artery bifurcation Doppler ultrasonography mapping. Methods: High resolution Doppler ultrasonography of 500 carotid bifurcations was performed in 192 women and 308 men before surgical treatment. Gender differences were analyzed based on B-mode, color-flow, duplex doppler transverse and longitudinal images. Diameter percent stenoses, plaque length, distal internal and common carotid artery diameters, and distance from the carotid bifurcation to the ear lobe were compared. Mean, standard deviation, minimum and maximum values were described. Statistical comparisons were performed based on Student' s t and χ2 tests. Results: Carotid stenoses averaged 70±11% (30-95%) in women and 72±12% (40-98%) in men (p=0.013). The prevalence of 90-99% stenosis was greater in men, 14.3 vs 7.8% (p=0.029). Carotid plaques were longer in men, 2.3±0.8 vs 1.9 ±0.6 cm (p<0.001). Mean diameters of the distal internal carotid artery, 4.9±0.9 vs 4.6 ±0.8 mm, and of the common carotid artery, 7.6±1.3 vs 7.1±1.4 mm, were greater in men (p=0.001). Th e distance from the ear lobe to the bifurcation was also greater in men, 5.9±1.1 vs 5.3±0.9 cm (p<0.001). Conclusions: Doppler ultrasonography preoperative mapping demonstrated that the parameters measured were greater in men than in women. Detailed planning of carotid plaque treatment must take into consideration individual differences such as those associated with the patient' s gender.Keywords: ultrasonography; carotid stenosis; surgery. ResumoContexto: A ecografia das artérias carótidas extracranianas já se estabeleceu como método diagnóstico de imagem pré-operatória, e para seguimento de pacientes. Objetivo: Avaliar diferenças do mapeamento ecográfico em função do gênero masculino ou feminino dos pacientes. Métodos: Ultrassonografia de alta resolução foi realizada antes do tratamento cirúrgico de 500 bifurcações carotídeas em 192 mulheres e 308 homens. Análise de diferenças baseadas no gênero foi feita em imagens modo B e fluxo a cor, transversal e longitudinal, e medidas duplex doppler de velocidades. Porcentual de estenose expressa em redução de diâmetro, comprimento de placa, diâmetros das artérias carótida interna distal e comum, e distância da bifurcação ao lóbulo da orelha foram comparados. Média, desvio padrão, mínimo e máximo foram descritos. Comparações estatísticas foram baseadas em testes t de Student e do χ 2 . Resultados: Estenoses carotídeas mediram 70±11% (30-95%) em mulheres e 72±12% (40-98%) em homens (p=0,013). Prevalência de estenoses no intervalo 90-99% foi mais alta em homens, 14,3 vs 7,8% (p=0,029). As placas foram mais extensas nos homens, 2,3±0,8 vs 1,9±0,6 cm (p<0,001). O diâmetro médio foi maior nos homens, tanto da carótida interna distal, 4,9±0,9 vs 4,6±0,8 mm, como da carótida comum, 7,6±1,3 vs 7,1±1,4 mm (p=0.001). A distância da bifurcação ao lóbulo da...

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“…Greater diameters among men were expected and confirmed 23,24 . The length of stay in the hospital was shorter in men compared to women 12 .…”

Section: Discussionsupporting

confidence: 60%

Mapeamento ecográfico da bifurcação das artérias carótidas extracranianas para planejamento cirúrgico: diferenças baseadas no gênero do paciente

Pontes¹,

Barros²,

Roelke³

et al. 2011

J. vasc. bras.

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“…[1][2][3][4] The underlying pathophysiologic mechanisms that explain these sexspecific differences are poorly understood. 5 The stability of the atherosclerotic plaque may be one of the factors that explain these findings. In line with previous observations showing a more unstable plaque phenotype in men, 6 we observed that PH in the atherosclerotic plaque is more prevalent in men with carotid artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Subgroup analyses from randomized trials have indicated that the risk reduction of stroke after carotid endarterectomy (CEA) is less evident in women than in men. [1][2][3][4][5] One of the possible factors contributing to this sex-associated difference is carotid plaque phenotype, which is significantly more stable in women, especially in asymptomatic patients. 6 Plaque hemorrhage (PH) may lead to accelerated progression of atherosclerotic disease.…”

mentioning

confidence: 99%

Sex Is Associated With the Presence of Atherosclerotic Plaque Hemorrhage and Modifies the Relation Between Plaque Hemorrhage and Cardiovascular Outcome

Vrijenhoek

Ruijter

Borst

et al. 2013

Stroke

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Background and Purpose-Plaque hemorrhage (PH) may lead to accelerated progression of atherosclerotic disease.The presence of local PH in the carotid plaque predicts future cardiovascular events in any vascular territory. We investigated the prevalence of local PH and the predictive value of PH for the occurrence of cardiovascular events in men and women separately. Methods-Atherosclerotic plaques from 1422 patients (969 men, 453 women) who underwent carotid endarterectomy were analyzed histologically for the presence of PH. Patients were monitored for 3 years for cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, vascular death, and vascular intervention). Results-Plaques from men showed a significantly higher prevalence of PH compared with women (67% versus 54%;P<0.001). In 1353 patients with available follow-up data, with a median duration of 2.9 years, 270 events had occurred in men (29%) and 94 in women (22%). Stratified by presence of PH, the event rate was 32% in men with PH versus 23% in men without PH, and 23% in women with PH versus 21% in women without PH. A multivariable Cox proportional hazards model found a significant interaction between sex and PH. PH was significantly associated with events in men (adjusted hazard ratio, 1.9; 95% CI, 1.2-2.8) but not in women (adjusted hazard ratio, 1.0; 95% CI, 0.6-1.7). Conclusions-Atherosclerotic carotid plaques obtained from men reveal a higher prevalence of PH compared with women. Local PH is strongly related to secondary manifestations of cardiovascular disease in men but not in women.

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“…[19][20][21][22][23][24][25][26][27][28][29] However, the overall evidence for outcome differences by gender-specific characteristics in the literature is limited. 30 Mantese et al found that sex did not modify the treatment effect. 31 Some authors emphasize that female sex alone is not an adjunctive risk factor for poor outcome after CEA in comparison to male patients, however subgroups of female patients at ahigher surgical risk can be distinguished -with contralateral occlusion or diabetes.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2017

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Mechanisms of gender-related outcome differences after carotid endarterectomy

Cited by 41 publications

References 77 publications

Mapeamento ecográfico da bifurcação das artérias carótidas extracranianas para planejamento cirúrgico: diferenças baseadas no gênero do paciente

Mapeamento ecográfico da bifurcação das artérias carótidas extracranianas para planejamento cirúrgico: diferenças baseadas no gênero do paciente

Sex Is Associated With the Presence of Atherosclerotic Plaque Hemorrhage and Modifies the Relation Between Plaque Hemorrhage and Cardiovascular Outcome

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

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