REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2019 December;26(4):159-63

DOI: 10.23736/S1824-4777.19.01435-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Clinical consideration of biologic sex on the choice of revascularization technique: does (should) sex affect the choice of carotid artery stenting versus carotid endarterectomy?

Angelica R. LACKEY ¹, Frederick DURHAM ¹, Jenifer H. VOEKS ², Brajesh K. LAL ¹ ✉

¹ Department of Vascular Surgery, University of Maryland, Baltimore, MD, USA; ² Department of Neurology, Medical University of South Carolina, SC, USA

Stroke is a devastating outcome of atherosclerotic carotid occlusive disease. As the second leading global cause of death and long-term disability, prevention of stroke is critical for the improvement of stroke-related mortality and morbidity. Sex differences are increasingly recognized in medicine. Women have a higher prevalence of stroke than men. This review summarizes published literature pertaining to differences in outcomes of revascularization procedures among women and men. Early evidence suggested no sex-specific differences for carotid endarterectomy (CEA) or carotid artery stenting (CAS) performed for carotid stenosis. More recent evidence indicates that there may be an increased risk of periprocedural stroke for women following either forms of revascularization. Some reports suggest an increased risk of stroke with CAS compared to CEA for women. Other registry reports argue against this conclusion and suggest that there is no sex-specific difference for CAS outcomes. All published studies presenting Level 1 data for periprocedural stroke and death after CEA and/or CAS are under-represented with respect to women and therefore do not provide reliable sex-specific information on stroke or death. Women appear to fare worse than men for both CAS and CEA. However, the reason for this is not defined and merits further investigation. Till then, carotid revascularization in appropriately selected men and women remains the mainstay for stroke-prevention. More studies containing enough women to generate the requisite statistical power are required.

KEY WORDS: Carotid arteries; Stents; Endarterectomy, carotid; Sex characteristics