The Influence of Gender on Clinical Outcomes and Durability of Repair Following Carotid Angioplasty with Stenting and Carotid Endarterectomy

Objectives: Studies have indicated that cerebrovascular disease may differ based on gender. Carotid angioplasty with stenting (CAS) and carotid endarterectomy (CEA) must be evaluated with this in mind.
Methods: 53 Patients that elected CAS (26 men and 27 women), and 48 patients that elected to undergo CEA (26 men and 22 women) were included in this study. Patients underwent surveillance duplex ultrasound at 6, 12, and 24 months post-procedure. The clinical outcomes of technical success, peri-procedural mortality, major adverse events, average length of stay, length of ICU admission, progression to critical re-stenosis, rate of change of lesions at 6-12 months, rate of change at 12-24 months, and recurrence of symptoms were assessed.
Results: Statistically significant differences in procedural success, peri-procedural mortality, major adverse events, and subsequent progression to critical re--stensosis as assessed by carotid duplex was not noted between men and women for both procedures (p=NS). However, the CEA patients had longer length of stays overall when compared to CAS patients (p<0.05). In addition, no difference was noted between men and women in terms of average change in velocity at 6-12 months, change in velocity in 12-24 months, or recurrence of symptoms following CAS and CEA (p=NS).
Conclusion: : CAS with distal protection compared to CEA was not associated with significant differences in clinical outcomes or re-stenosis rates between men and women up to 24 months post-procedure. CEA and CAS can be accomplished in women with clinical outcomes and durability comparable to men.