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Age and gender disparities in the risk of carotid revascularization procedures

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Abstract

The potential effect of age and gender stratification in the outcome of patients with carotid artery stenosis undergoing carotid revascularization procedures (CRP) may have important implications in clinical practice. Both European Stroke Organization and American Heart Association guidelines suggest that age and sex should be taken into account when selecting a CRP for an individual patient. We reviewed available literature data through Medline and Embase. Our search was based on the combination of terms: age, gender, sex, carotid artery stenosis, carotid artery stenting (CAS) and carotid endarterectomy (CEA). Postoperative stroke and mortality rates increased with age after any CRP (CEA or CAS), especially in patients aged over 75 years. Older patients with carotid artery stenosis undergoing CAS were found to have a nearly double risk of stroke or death compared with CEA, while CEA was found to benefit more patients aged over 70 years with symptomatic carotid artery stenosis. Male patients with symptomatic or asymptomatic carotid artery stenosis had lower stroke/mortality rates and benefited more from CEA compared with females. For the periprocedural risk of stroke or death in patients with carotid artery stenosis after CAS no sex differences were found. Therefore, CEA appears to have lower perioperative risks than CAS in patients aged over 70 years, and thus should be the treatment of choice if not contraindicated. The periprocedural risk of CEA is lower in men than in women, while there was no effect of gender on the periprocedural risk of CAS.

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Abbreviations

RCT:

Randomized clinical trial

CEA:

Carotid endarterectomy

CAS:

Carotid artery stenting

ACST:

Asymptomatic carotid surgery trial

ECST:

European carotid surgery trial

NASCET:

North American symptomatic carotid endarterectomy trial

VACSP:

Veterans affairs cooperative studies program

CREST:

Carotid revascularization versus stenting trial

EVA-3S:

Endarterectomy versus angioplasty in patients with severe symptomatic carotid stenosis

SPACE:

Stent-protected angioplasty versus carotid endarterectomy

ICSS:

International carotid stenting study

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Author information

Authors and Affiliations

  1. Department of Neurology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece

    Sotirios Giannopoulos & Aristeidis H. Katsanos

  2. Vascular Unit, Third Department of Surgery, School of Medicine, University of Athens, Athens, Greece

    Spyros N. Vasdekis

  3. Second Department of Neurosurgery, School of Medicine, University of Athens, Athens, Greece

    Efstathios Boviatsis

  4. Second Department of Neurology, School of Medicine, University of Athens, Athens, Greece

    Konstantinos Ι. Voumvourakis & Georgios Tsivgoulis

  5. International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic

    Georgios Tsivgoulis

Authors
  1. Sotirios Giannopoulos
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  2. Aristeidis H. Katsanos
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  3. Spyros N. Vasdekis
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  4. Efstathios Boviatsis
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  5. Konstantinos Ι. Voumvourakis
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  6. Georgios Tsivgoulis
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Correspondence to Aristeidis H. Katsanos.

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Giannopoulos, S., Katsanos, A.H., Vasdekis, S.N. et al. Age and gender disparities in the risk of carotid revascularization procedures. Neurol Sci 34, 1711–1717 (2013). https://doi.org/10.1007/s10072-013-1453-2

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  • DOI: https://doi.org/10.1007/s10072-013-1453-2

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