Abstract
Transient ischemic attack (TIA)/stroke patients with coexisting cardiovascular (CV) disease remain at high risk of recurrent ischemic events despite current management. More intensive lipid-lowering agents might be justified, but benefit from increased antithrombotic agents might be offset by higher risk of extracranial bleeding.
Highlights
Summary: This retrospective multicenter review conducted between 2004 and 2017 reviewed 406 consecutive patients (287 in derivation cohort, 219 in validation cohort) with uncomplicated type B aortic dissection (UTBAD)
Comments: Several studies have suggested that women who undergo CEA have higher perioperative stroke rates and recurrent stenosis than men, other papers show no difference
I do not believe women are inherently at higher risk of perioperative stroke owing to physiologic factors, but they have smaller arteries that are more susceptible to technical errors and recurrent stenosis owing to intimal hyperplasia
Summary
Comments: Several studies have suggested that women who undergo CEA have higher perioperative stroke rates and recurrent stenosis than men, other papers show no difference. The surgeon found the arteries in women were smaller and avoided performing conventional CEA with primary closure and eversion endarterectomy in females and instead favored patching in women, which results in a larger residual lumen after endarterectomy. I would recommend primary closure never be performed in women undergoing conventional CEA. I do not believe women are inherently at higher risk of perioperative stroke owing to physiologic factors (the mortality and cardiac event rate was not higher), but they have smaller arteries that are more susceptible to technical errors and recurrent stenosis owing to intimal hyperplasia. Patients with smaller arteries should undergo CEA using patch closure and not primary repair, regardless of whether they are men or women. Matsushita A, Tabata M, Mihara W, Shimamoto T, Komiya T, Takanashi S, et al J Thorac Cardiovasc Surg 2019 Jun 20 [Epub ahead of print]
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