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

• Published in: Journal of vascular surgery 2011-06, Vol.53 (6), p.1457-1464
• Main Authors: Rockman, Caron B., MD, RVT, Garg, Karan, MD, Jacobowitz, Glenn R., MD, Berger, Jeffrey S., MD, Mussa, Firas F., MD, Cayne, Neal S., MD, Adelman, Mark A., MD, Maldonado, Thomas S., MD
• Format: Article
• Language: English
• Subjects: Angioplasty - adverse effects; Angioplasty - statistics & numerical data; Biological and medical sciences; Carotid Arteries - surgery; Carotid Artery Diseases - surgery; Databases, Factual; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - statistics & numerical data; Female; Hospital Mortality; Humans; Male; Medical sciences; Neurology; Sex Factors; Stents; Stroke - epidemiology; Stroke - etiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; United States - epidemiology; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.02.029

Background The benefit of carotid endarterectomy (CEA) in female patients has been questioned by various randomized, prospective trials, particularly in asymptomatic cases; several have noted an increase in perioperative stroke among women after CEA. The outcome of carotid angioplasty and stenting (CAS) has not been extensively examined in women. This study examined the outcome of CEA and CAS in women vs men by using a national database. Methods Outcomes of CEA and CAS were stratified by sex using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. The NIS was used to identify patient discharges that occurred during 2004 and 2005. Appropriate International Classification of Diseases, 9th Revision (ICD-9) procedure and diagnosis codes were used to identify CEA and CAS cases. Outcome measures included in-hospital perioperative stroke and death. Comparisons of demographics, procedures, and outcome were performed between men and women. Additional analysis was performed among women alone to attempt to identify whether improved outcome was noted with either procedure. Results Of 54,658 procedures, 94.2% were CEA and 5.8% were CAS. Women comprised 42.3% of the analyzed cases. Women and men were equally likely to be symptomatic (5.3% vs 5.3%, P = .8). Women were significantly less likely to undergo CAS than men (5.4% vs 6.1%, P < .001). Women and men had equivalent rates of perioperative stroke when undergoing CEA (1.0% vs 1.0%, P = .9) and CAS (2.7% vs 2.0%, P = .2). Symptomatic women had a significantly higher rate of perioperative stroke overall than did symptomatic men (3.8% vs 2.3%, P = .03). Asymptomatic women had a significantly lower perioperative stroke rate after CEA than after CAS (0.9% vs 2.1%, P < .001). Rates of perioperative showed a trend favoring CEA vs CAS among symptomatic women (3.4% vs 6.2%, P = .1). Conclusions The concern regarding an increased perioperative stroke rate after CEA among asymptomatic women appears to be unfounded. The perioperative stroke rate among symptomatic women was higher than that of symptomatic men, but still well within the acceptable range for symptomatic patients undergoing a cerebrovascular intervention. Nationally, women underwent CAS significantly less frequently than did men. Outcome among women for perioperative stroke favored CEA over CAS, particularly in asymptomatic patients. CEA may be the preferred treatment