The influence of female gender on the outcome of carotid endarterectomy: Achallenge to the ACAS findings

Background. In the Asymptomatic Carotid Endarterectomy Study (ACAS) the per ioperative stroke and mortality rate was more than twice as high in women a s in men, markedly reducing the long-term benefit of the operation; therefo re the role of carotid endarterectomy (CEA) among women with asymptomatic c arotid stenoses remains unclear. The current study was undertaken to furthe r examine the influence of gender on the outcome of the operation. Methods. To control for all variables except gender; the records of all pat ients in an academic medical center who underwent elective CEA for asymptom atic disease, performed by one surgeon employing a uniform technique, over a 7-year interval were reviewed. Results. From January 1992 through September 1998, 156 CEA procedures for a symptomatic carotid stenoses were performed on 66 (44%) women (n = 68) and 83 (56%) men (n = 88). There were no differences in the prevalence of hyper tension (69% vs 69%), diabetes mellitus (24% vs 6%, P <.01) was more common among men. The mean stenasis was 86% for men and 83% for women. The incide nce of peri-operative mortality, stroke, and transient ischemic events was 0% vs 0%, respectively. Conclusions. These findings indicate that female gender does not adversely influence the outcome of CEA when performed for treatment of asymptomatic d isease. Gender should not be a consideration in the decision to perform CEA because of asymptomatic disease.