Carotid Interventions: Does Sex Matter?

Abstract

Multicentre randomised controlled trials (RCTs) consistently report that females with symptomatic and asymptomatic carotid stenoses gain less benefit following carotid interventions, compared with males. This was evident when carotid endarterectomy (CEA) was compared with best medical therapy (BMT) 1 Naylor A.R. Rothwell P.M. Bell P.R.F. Overview of the principal results and secondary analyses from the European and the North American randomised trials of carotid endarterectomy. Eur J Vasc Endovasc Surg. 2003; 26: 115-129 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar ,2 Rothwell P.M. Goldstein L.B. Carotid Endarterectomy for Asymptomatic Carotid Surgery Trial. Stroke. 2004; 35: 2425-2427 Crossref PubMed Scopus (0) Google Scholar and when CEA was compared with carotid artery stenting (CAS). 3 Batchelder A. Saratzis A. Naylor A.R. Overview of primary and secondary analyses from 20 randomised controlled trials comparing carotid artery stenting with carotid endarterectomy. Eur J Vasc Endovasc Surg. 2019; 58: 479-493 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar The reduced benefit in females has been attributed to a combination of higher 30 day rates of death or stroke (vs. males) and a lower natural history risk of stroke on BMT, compared with males. These two factors have probably led to a greater proportion of females being denied carotid interventions (especially if asymptomatic). However, females are generally under represented in RCTs, and patients randomised within RCTs tend to be a highly selected subgroup of the overall population being treated, which raises questions about RCT generalisability in real world practice. Sex Related Differences in Indication and Procedural Outcomes of Carotid interventions in VASCUNETEuropean Journal of Vascular and Endovascular SurgeryPreviewIt has been suggested that peri-operative complications after carotid surgery may be higher in women than in men. This assumption may affect the treatment patterns, and it is thus possible that carotid endarterectomy (CEA) is provided to women less often. The aim of the current VASCUNET study was to determine sex related differences in operative risk in routine clinical practice among non-selected patients undergoing carotid revascularisation. Full-Text PDF Open Access