Gender Differences and Outcome of Conservatively Treated Patients with Asymptomatic High-grade Carotid Stenosis

Abstract

Conclusion: Males with high-grade carotid stenosis have a higher risk of poor outcome than females with high-grade carotid artery stenosis. Summary: This study examined gender differences in all forms of vascular outcome and mortality in patients with high-grade carotid stenosis and no neurologic symptoms. There were 525 patients enrolled, 325 males, median age 72 years, and 200 females median age 75 years. All patients were enrolled in a single center registry and were treated medically for asymptomatic greater than 70% internal carotid artery stenoses. Median follow up was 38 months (interquartile range 18-65 months). Patients were followed for major adverse carodiovascular, cerebral, and peripheral vascular events. A combined endpoint included stroke, myocardial infarction, vascular mortality, partial limb amputation and death (MACE). Cumulative MACE-free survival rates in females and males at 1, 3, and 5 years, were 85%, 73%, and 67%, versus 83%, 65%, and 48% (p = 0.004). Adjusted hazard ratios for MACE, vascular mortality and all cause mortality at 1, 3 and 5 years for males compared with females were 1.96 (p = 0.016), 2.48 (p < 0.001), and 1.70 (p = 0.007). This was irrespective of age, vascular risk factors, comorbidities and individual risk status determined by the American Society of Anesthesiologists. Comment: The authors found male patients with asymptomatic high-grade carotid stenosis do more poorly than female counterparts. The findings are irrespective of vascular risk factors, comorbidities and age. Gender related differences in outcomes of patients with asymptomatic high-grade carotid stenosis may have some implication for monitoring as well as strategies for intervention and prophylactic repair of asymptomatic high-grade carotid stenosis.