Carotid endarterectomy in female patients: Are the concerns of the Asymptomatic Carotid Atherosclerosis Study valid?

Objectives: Although the results of the Asymptomatic Carotid Atherosclerosi s Study clearly demonstrated the benefit of surgical over medical managemen t of severe carotid artery stenosis, the results for women in particular we re less certain. This was to some extent because of the higher perioperativ e complication rate observed in the 281 women (3.6% vs 1.7% in men). The ob jective of this study was to review a large experience with carotid endarte rectomy in female patients and to determine whether the perioperative resul ts differed from those of male patients. Methods: A review was conducted of a prospectively compiled database on all carotid endarterectomies performed between 1982 and 1997. Operations perfo rmed in 991 female patients were compared with those performed in 1485 male patients. Results: Female patients had a significantly lower incidence of diabetes, c oronary artery disease, and contralateral carotid artery occlusion than did male patients. Female patients had a significantly higher incidence of hyp ertension. There were no significant differences in the age, smoking histor y, anesthetic route, shunt use, or clamp tolerance between the two groups. Of 991 female patients, 659 (66.5%) had preoperative symptoms, whereas 332 (33.5%) cases were performed for asymptomatic stenosis. Among 1485 male pat ients, 1041 (70.1%) had symptoms, and 444 (29.9%) were symptom free before surgery. There were no significant differences noted in the perioperative s troke rates between men and women overall (2.3% vs 2.4%, P = .92), or when divided into symptomatic (2.5% vs 3.0%, P = .52) and asymptomatic (2.0% vs 1.2%, P = .55) cases. Conclusions: Carotid endarterectomy can be performed with equally low perio perative stroke rates in men and women in both symptomatic and asymptomatic cases. In this series, symptom-free female patients had the lowest overall stroke rate. The concerns of the Asymptomatic Carotid Atherosclerosis Stud y regarding the benefit of carotid endarterectomy in female patients should therefore not prevent clinicians from recommending and performing carotid endarterectomy in appropriately selected symptom-free female patients.