on February 10, 2009
Published online before print February 10, 2009, doi: 10.1161/STROKEAHA.108.541847
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Submitted on November 15, 2008
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. * To whom correspondence should be addressed. 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 ( 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.
Revised on January 5, 2009
Accepted on January 7, 2009
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*;
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).
Key words: carotid artery stenting • carotid stenosis • complications • gender differences • sex • women
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