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(Stroke. 2003;34:1124.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Female Sex: A Questionable Risk Factor for Carotid Endarterectomy

Section of Vascular Surgery, Department of Medical and Surgical Sciences, University of Padua School of Medicine, Padua, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The misconception that clinical manifestations of cardiovascular disease are a much more significant problem among male patients is hard to eliminate, supported by the higher incidence of cardiac, cerebrovascular, and peripheral arterial diseases in men than in women.¹

Our understanding of cerebrovascular disease in women is hampered by a paucity of studies including an adequate number of female patients. Most studies are heavily biased toward the male sex. The efficacy of aspirin in primary and secondary stroke prevention trials has been demonstrated almost exclusively in men.² Men were also the majority of the population recruited in the major clinical trials on symptomatic (North American Symptomatic Carotid Endarterectomy Trial [NASCET] and European Carotid Surgery Trial [ECST])^3,4 and asymptomatic (Asymptomatic Carotid Atherosclerosis Study [ACAS]) carotid stenoses,⁵ and no women were enrolled in the Veteran Administration trials.^6,7 Unfortunately, neither the original report from the NASCET nor the one from ECST analyzed data specifically by sex. Although the superiority of carotid endarterectomy (CEA) over the best medical management in protecting against stroke for selected symptomatic and asymptomatic patients with carotid lesions was well demonstrated,^3–7 post-hoc analyses,^8,9 along with several reviews and large single-center studies, have prompted a reevaluation of the role of CEA in women.^10–14

The NASCET results did not distinguish, however, between men and women with regard to perioperative risk in patients with severe stenosis,³ and they showed no apparent benefit from CEA in women with moderate stenosis.⁸ Furthermore ACAS investigators found a slightly higher, albeit statistically insignificant, perioperative stroke and/or death rate . . . [Full Text of this Article]

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