IP091. Impact of Sex on Carotid Artery Stenting Outcomes Among Octogenarians

Abstract

Carotid artery stenting (CAS) has been validated as an acceptable alternative to carotid endarterectomy in patients at high risk for open surgery. There are variable sex- and age-based differences in CAS outcomes based on published randomized control trials. The aim of our study was to evaluate sex-based differences in perioperative outcomes after CAS performed in octogenarians. The National Surgical Quality Improvement Program vascular-targeted data file was queried for all patients 80 years of age and older who underwent CAS between 2011 and 2017. Symptomatic status was defined as a history of prior ipsilateral stroke, transient ischemic attack (TIA), or amaurosis fugax. The primary outcome was a composite outcome of perioperative (30-day) stroke, TIA, death, and/or myocardial infarction (MI). Outcomes were compared for males versus females and stratified by symptomatic status using univariable and multivariate logistic regression analyses adjusting for emergent status, symptomatic status, comorbidities, and use of an embolic protection device. Overall, there were 143 octogenarian patients who underwent CAS over the study period, including 95 males (66.4%) and 48 females (33.6%). Median age was 83.9 years (range, 80-90 years), 85.3% were white, and 30.3% were symptomatic. One-third (37.1%) had anatomic high-risk criteria for CEA, while the remainder (62.9%) had high-risk medical comorbidities. Periprocedural stroke/TIA/death/myocardial infarction occurred in 10 males (10.5%) versus 5 females (10.4%; P = .98), and did not significantly differ according to symptomatic versus asymptomatic status (11.6% vs 10.0%; P = .77). Based on multivariable analysis, independent factors associated with a poor periprocedural outcome included emergent versus elective status (adjusted odds ratio [aOR], 21.3; 95% confidence interval [CI], 2.74-165.39) and failure to use an embolic protection device (aOR 4.39; 95% CI, 1.20-16.00). Sex was not associated with the primary outcome after risk adjustment (aOR 0.8; 95% CI, 0.21-2.99). Contrary to prior findings suggesting worse post-CAS outcomes among females, we found no sex-based differences in risk of perioperative stroke, TIA, death, or myocardial infarction among patients 80 years of age and older undergoing CAS. Our study validates previous studies showing a high rate of perioperative complications following CAS in an older population, and reinforces the importance of patient selection and use of an embolic protection device to reduce poor outcomes.