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(Stroke. 2009;40:1140.)
© 2009 American Heart Association, Inc.

Go Red for Women

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

Virginia J. Howard, PhD; Jenifer H. Voeks, PhD; Helmi L. Lutsep, MD; Ariane Mackey, MD, FRCP(C); Genevieve Milot, MD, FRCS(C); Albert D. Sam, II, MD; MeeLee Tom, MS; Susan E. Hughes, BSN; Alice J. Sheffet, PhD; Mary Longbottom, BA; Jason B. Avery, MPH; Robert W. Hobson, II, MD Thomas G. Brott, MD

From the Department of Epidemiology (V.J.H., J.H.V., J.B.A.), School of Public Health, University of Alabama at Birmingham, Birmingham, Ala; Oregon Health & Science University (H.L.L.), Portland, Ore; the Department of Neurological Sciences (A.M., G.M.), Hopital de L’Enfant Jesus, Laval University, Quebec, Canada; Vascular Specialty Associates (A.D.S.), Baton Rouge, La; the Department of Surgery (M.L., S.E.H., A.J.S., R.W.H.), University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ; and the Department of Neurology (M.L., T.G.B.), Mayo Clinic, Jacksonville, Fla.

Correspondence to Virginia J. Howard, PhD, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294-0022. E-mail vjhoward{at}uab.edu

Background and Purpose— Several carotid endarterectomy randomized, controlled trials and series have reported higher perioperative stroke and death rates for women compared with men. The potential for this same relationship with carotid artery stenting was examined in the lead-in phase of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).

Methods— CREST compares efficacy of carotid endarterectomy and carotid artery stenting in preventing stroke, myocardial infarction, and death in the periprocedural period and ipsilateral stroke over the follow-up period. CREST included a "lead-in" phase of symptomatic (50% stenosis) and asymptomatic (70% stenosis) patients. Patients were examined by a neurologist preprocedure, at 24 hours, and at 30 days. Review of stroke and death was by an independent events committee. The association of sex with periprocedural stroke and death was examined in 1564 patients undergoing carotid artery stenting (26.5% symptomatic).

Results— Women comprised 37% of the lead-in cohort and did not differ from men by age, symptomatic status, or characteristics of the internal carotid artery. The 30-day stroke and death rate for women was 4.5% (26 of 579; 95% CI, 3.0% to 6.5%) compared with 4.2% (41 of 985; 95% CI, 3.0% to 5.6%) for men. The difference in stroke and death rate was not significant nor were there any significant differences by sex after adjustment for age, arterial characteristics, or cardiovascular risk factors.

Conclusions— These results do not provide evidence that women have a higher carotid artery stenting stroke and death rate compared with men. The potential differential periprocedural risk by sex will be prospectively addressed in the randomized phase of CREST.

Key Words: carotid artery stenting • carotid stenosis • complications • gender differences • sex • women

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