Comparative Analysis of Endarterectomy and Stenting For the Treatment of Carotid Stenosis in Women

Abstract

Although large randomized studies have established the efficacy and safety of carotid endarterectomy (CEA) and stenting (CAS), the under-representation of women leaves the comparison of risks to benefits of performing these procedures on women an open question. To address this issue, we delineated patient characteristics predicting outcomes in women undergoing carotid interventions. We analyzed in-hospital mortality, postoperative stroke, and the composite end points of stoke or death in 20,620 hospitalizations in New York and Florida for 2007 to 2009. Univariate and multivariable logistic regression analyses were performed. CEAs were performed in 16,576 asymptomatic and in 1744 symptomatic women and CAS in 1948 asymptomatic and in 352 symptomatic women. Compared with CAS, CEA rates were significantly lower for in-hospital mortality, stroke, and combined stroke/mortality (Table). Cardiac complication rates did not differ among asymptomatic women, but cardiac complications were more frequent among symptomatic women with CAS (10.5% vs 6.5%, P = .008). Among symptomatic women, the presence of renal disease, CAD, or age ≥80 years increased the risk of CAS over CEA threefold for the composite end point of stroke or death. For asymptomatic women, only in those with CAD or diabetes, there was a significant difference in the mortality/stroke rates favoring CEA. After adjusting for relevant clinical and demographic risk factors, CAS increased the risk for the composite end point of stoke or death in both symptomatic and asymptomatic patients.TableOutcomeAsymptomaticSymptomaticCEA, %CAS, %PCEA, %CAS, %PMortality0.30.8.00070.43.4<.0001Post-op stroke1.52.6.00043.59.7<.0001Stroke/mortality1.73.1<.00013.811.1<.0001 Open table in a new tab These databases reflect real-world practice performance of the management of carotid disease in women and suggest that CEA has better perioperative outcomes in women. Importantly, CAS is associated with significant morbidity in certain clinical settings, and this should be taken into account when choosing a revascularization procedure.