Gender and carotid endarterectomy: Does it matter?

Objective: Multiple large series have retrospectively identified female gen der as a risk factor for perioperative stroke and death after carotid endar terectomy (CFA). Methods: Data for all patients who underwent CEA at a single institution fr om January 1990 to December 1998 were entered into a computerized vascular registry and form the basis of this report. Results: A total of 1298 CEA procedures were performed, of which 520 (40%) were in women and 778 (60%) in men. The mean age was 69.8 +/- 8.7 years for men and 71.2 +/- 8.5 years for women (P < .001). Cardiac risk factors sign ificantly varied among the two groups, with women more likely to have diabe tes (42% vs 36%) and hypertension (77% vs 66%), whereas tobacco history was higher among men (85% vs 71%) (P < .05 for all). Female patients were more likely to be asymptomatic at presentation (men, 44% vs women, 51%; P = .02 2). Postoperative myocardial infarction occurred in eight patients (0.6%) w ith no differences between men (0.4%) and women (1.0%) (P = not significant ). For all adverse postoperative cardiac events (myocardial infarction, con gestive heart failure, or arrhythmia), the incidence was 1.9% (25 patients) , again with no differences between men (1.5%) and women (2.5%) (P = not si gnificant). There were 25 postoperative neurologic events (19 strokes, six transient ischemic attacks) among the entire cohort (1.9%), of which 16 wer e in men (2.1%) and nine in women (1.6%; P = not significant). The overall postoperative stroke rate was 1.5% (13 [1.7%] of 778 men; 6 [1.2%;] of 520 women; P = not significant). Total operative mortality was 0.3% (3 [0.4%] o f 778 men; 1 [0.2%] of 778 women; P = not significant). Late recurrent sten osis requiring operation developed in 14 patients (1.1%) during follow-up ( 6 [0.8%] of 778 men; 8 [1.5%] of 520 women; P = .19). Conclusions: Although there is significant variability in cardiac risk fact ors and presentation, female gender is not a risk factor for stroke, death, or cardiac morbidity after CEA. Women are not at higher risk for reoperati on for recurrent stenosis.