December 30, 2019
1 min read

In carotid surgery, but not CAS, women at greater stroke risk vs. men

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Niveditta Ramkumar

PHILADELPHIA — Women with carotid stenosis were more likely to undergo carotid endarterectomy instead of angioplasty and stenting compared with men, but women were more likely than men to have stroke after carotid endarterectomy, according to findings presented at the American Heart Association Scientific Sessions.

There was no difference in stroke risk between women and men after carotid artery stenting, researchers reported.

In a cohort of 31,207 patients with carotid stenosis, 13% (39% women) underwent carotid artery stenting and had a median survival of 2 years (interquartile range, 1-3.4). After adjustment, researchers found that women were less likely to undergo CAS than men (HR = 0.87; 95% CI, 0.77-0.99) when presenting at the same age (75 years).

“Stroke is the third leading cause of death in women and carotid stenosis, which is the narrowing carotid artery is a significant risk factor for stroke,” Niveditta Ramkumar, MPH, PhD student at the Dartmouth Institute for Health Policy and Clinical Practice, said during her presentation. “Carotid stenosis can be treated with endovascular surgery, but the sex-specific efficacy of these interventions remains unknown.”

In asymptomatic patients, women were more likely to have stroke at 5 years after carotid endarterectomy than men (adjusted HR = 1.19; 95% CI, 1-1.42), but there was no difference between the sexes in 5-year stroke risk after CAS (aHR = 1.39; 95% CI, 0.86-2.24), according to the researchers. The trends in symptomatic patients were similar (aHR for stroke after endarterectomy = 1.34; 95% CI, 1.13-1.58; aHR for stroke after CAS = 1.35; 95% CI, 0.97-1.87).

Researchers assessed patients 65 years and older who underwent carotid endarterectomy or angioplasty and stenting from 2010 to 2015 in the Vascular Quality Initiative-Medicare linked dataset with the aim of determining the association between sex and treatment type for carotid stenosis and stroke.

“[It] seems like women are more likely to undergo carotid endarterectomy vs. carotid angioplasty and stenting,” Ramkumar said. “After carotid endarterectomy, women have a higher risk for postoperative stroke than men, even after risk adjustment. This is particularly interesting since carotid endarterectomy is widely used in the treatment of carotid stenosis.” – by Scott Buzby


Ramkumar N, et al. Presentation 226. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.

Disclosure: Ramkumar reports no relevant financial disclosures.