Carotid endarterectomy in women - Challenging the results from ACAS and NASCET

Objective To evaluate and compare the short- and long-term outcomes in fema le and male patients after carotid endarterectomy (CEA). Summary Background Data Randomized carotid trials have clearly shown the be nefits of CEA in specific symptomatic and asymptomatic patients. However, t he short- and long-term benefits in women appear to be less clear, and the role of CEA among women with carotid disease remains uncertain. Methods During a 21-year period, 1,204 CEAs were performed, 464 (39%) in wo men and 739 (61%) in men. Complete follow-up was available in 70% of patien ts. Results Women were less likely to have evidence of coronary artery disease, were more likely to be hypertensive, and had a significantly greater incid ence of diabetes. The mean age at CEA was 68.5 +/- 9.5 years for women and 68.0 +/- 8.5 years for men. There were no significant differences in the us e of shunts, patching, tacking sutures, or severity of carotid stenoses bet ween men and women. Surgical death rates were nearly identical for asymptom atic and symptomatic patients. Perioperative stroke rates were similar for asymptomatic and symptomatic patients. Life-table stroke-free rates at 1, 5 , and 8 years were similar for asymptomatic women and men and symptomatic w omen and men. Long-term survival rates at 1, 5, and 8 years were higher for asymptomatic women compared with men and for symptomatic women compared wi th men. As a result, stroke-free survival rates at these follow-up interval s were greater for asymptomatic women compared with men, and for symptomati c women compared to men. Conclusions The results from this study challenge the conclusions from the Asymptomatic Carotid Endarterectomy Study and the North American Symptomati c Carotid Endarterectomy Trial regarding the benefits of CEA in women. Fema le gender did not adversely affect early or late survival, stroke-free, or stroke-free death rates after CEA. The authors conclude that CEA can be per formed safely in women with asymptomatic and symptomatic carotid artery dis ease, and physicians should expect comparable benefits and outcomes in wome n and men undergoing CEA.