Jeffrey Jim1, Ellen D. Dillavou2, Gilbert R. Upchurch3, Nicholas H. Osborne4, Christopher T. Kenwood5, Flora S. Siami5, Rodney A. White6, Joseph J. Ricotta7
1Washington University School of Medicine, St Louis, MO; 2University of Pittsburgh Medical Center, Pittsburgh, PA; 3University of Virginia, Charlottesville, VA; 4University of Michigan School of Medicine, Ann Arbor, MI; 5New England Research Institutes, Inc, Watertown, MA; 6Harbor-UCLA, Los Angeles, CA; 7Northside Heart and Vascular Institute, Atlanta, GA.
OBJECTIVES: While optimal treatment of carotid stenosis remains unclear, available data suggest that women have higher risk of adverse events after carotid revascularization. SVS-VR data was used to determine the impact of gender after CEA and CAS.
METHODS: 10,319 patients (41% women) underwent CEA (6,518) and CAS (3,801). The primary endpoint was a composite of death, stroke and myocardial infarction (MACE) at 30 days. The effect of symptom status and gender on outcomes was also analyzed.
RESULTS: There was no difference in age between genders, but men were more likely to be symptomatic (41% vs. 39%). Women were more likely to have hypertension and COPD while men had a higher prevalence of CAD and smoking history. For disease etiology in CAS, restenosis was more common in women (28% vs. 21%) while radiation was higher in men (7% vs. 3%). MACE was lower for CEA in all patient groups in both genders (p< 0.05 for all comparisons between CEA and CAS). Comparing women and men (Table 1), there were no statistically significant differences in MACE for either CEA (4% vs. 4%) or CAS (7% vs. 7%), which remained even after stratification by symptomatology and multivariate risk adjustment.
CONCLUSIONS: In this large, real-world analysis, women and men demonstrated similar results after CEA or CAS. These data suggest that, contrary to previous reports, women derive similar benefits as men from carotid revascularization. However, CAS is associated with inferior outcomes compared to CEA for both women and men, regardless of symptom status.
AUTHOR DISCLOSURES: E. D. Dillavou: Nothing to disclose; J. Jim: Nothing to disclose; C. T. Kenwood: Nothing to disclose; N. H. Osborne: Nothing to disclose; J. J. Ricotta: Nothing to disclose; F. S. Siami: Nothing to disclose; G. R. Upchurch: Nothing to disclose; R. A. White: Nothing to disclose.
Table 1: 30-day MACE by procedure
| Symptomatic CEA
| Asymptomatic CAS
Posted April 2013