This Article Full Text Full Text (PDF) All Versions of this Article: 36/1/27    most recent 01.STR.0000149622.12636.1fv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alamowitch, S. Search for Related Content PubMed PubMed Citation Articles by Alamowitch, S. Related Collections Carotid Stenosis Risk Factors for Stroke Carotid endarterectomy

(Stroke. 2005;36:27.)
© 2005 American Heart Association, Inc.

Original Contributions

The Risk and Benefit of Endarterectomy in Women With Symptomatic Internal Carotid Artery Disease

Sonia Alamowitch, MD; Michael Eliasziw, PhD Henry J.M. Barnett, MD for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the ASA and Carotid Endarterectomy (ACE) Trial Groups

From the Stroke Unit (S.A.), Department of Neurology, Tenon Hospital, AP-HP, Paris, France; the Department of Community Health Sciences (M.E.), University of Calgary, Calgary, Alberta, Canada; and the Department of Clinical Neurosciences, University of Calgary; The John P. Robarts Research Institute (H.J.M.B.), London, Ontario, Canada.

Correspondence to Dr Michael Eliasziw, Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada. E-mail eliasziw{at}ucalgary.ca

Background and Purpose— Perioperative risk and long-term benefit of carotid endarterectomy (CE) are not detailed in women with symptomatic internal carotid artery (ICA) stenosis. Our aim was to compare the efficacy of CE versus medical therapy in women and men with symptomatic ICA stenosis.

Methods— Data were taken from the North American Symptomatic Carotid Endarterectomy Trial (873 women, 2012 men) and the ASA and Carotid Endarterectomy trial (335 women, 813 men).

Results— The 30-day perioperative risk of death was higher in women than in men (2.3% versus 0.8%, P=0.002). Higher perioperative risk of stroke and death was also observed (7.6% versus 5.9%) but not statistically significant. With 70% stenosis, the 5-year absolute risk reduction (ARR) in stroke from CE was similar between women (15.1%) and men (17.3%). With 50% to 69% stenosis, CE was not beneficial in women (ARR=3.0%, P=0.94), contrary to men (ARR=10.0%, P=0.02). Medically treated women had low risk for stroke. A stroke prognosis instrument (SPI-II) assigned points to 7 factors that identified higher risk for medically treated women: 3 points for hemispheric (not retinal) event, history of diabetes, previous stroke; 2 for age older than 70 years, stroke (not transient ischemic attack); 1 for severe hypertension, history of myocardial infarction. CE was beneficial only for 29.0% of women with 50% to 69% stenosis who had the highest total score of 8 to 15 (ARR=8.9%).

Conclusions— Women and men with 70% symptomatic stenosis had similar long-term benefit from CE, although the perioperative risks were higher for women. CE was not beneficial for women with 50% to 69% stenosis without other risk factors for stroke.

Key Words: carotid endarterectomy • carotid stenosis • stroke, ischemic • women

This article has been cited by other articles:

				V. J. Howard, J. H. Voeks, H. L. Lutsep, A. Mackey, G. Milot, A. D. Sam II, M. Tom, S. E. Hughes, A. J. Sheffet, M. Longbottom, et al. Does Sex Matter? Thirty-Day Stroke and Death Rates After Carotid Artery Stenting in Women Versus Men: Results From the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) Lead-in Phase Stroke, April 1, 2009; 40(4): 1140 - 1147. [Abstract] [Full Text] [PDF]

				H. J.M. Barnett Personal Reflections From a Front-Row Seat at the Greatest Show on Earth (Life): Part II (Stroke Research Commentary) Stroke, March 1, 2009; 40(3): e53 - e65. [Full Text] [PDF]

				P. Fayad Endarterectomy and Stenting for Asymptomatic Carotid Stenosis: A Race at Breakneck Speed Stroke, February 1, 2007; 38(2): 707 - 714. [Abstract] [Full Text] [PDF]

				A. I. Qureshi, M. F. K. Suri, J. Zhou, and A. A. Divani African American women have poor long-term survival following ischemic stroke. Neurology, November 14, 2006; 67(9): 1623 - 1629. [Abstract] [Full Text] [PDF]

				J. Lohr and K. Simlote The Risk and Benefit of Endarterectomy in Women with symptomatic Internal Carotid Artery Disease Perspectives in Vascular Surgery and Endovascular Therapy, December 1, 2005; 17(4): 378-1 - 379. [Abstract] [PDF]

				J. B. Chang, T. A. Stein, M. Eliasziw, S. Alamowitch, and H. J.M. Barnett The Risk and Benefit of Endarterectomy In Women With Symptomatic Internal Carotid Artery Disease * Response: Stroke, July 1, 2005; 36(7): 1357 - 1358. [Full Text] [PDF]