Carotid Artery Stenting in Clinical Practice: Does Sex Matter? Results From the Carotid Artery Stenting Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Abstract

Background:Carotid artery stenting (CAS) is increasingly used for treatment of severe carotid artery stenosis, but only few procedural risk factors for complications of CAS are clearly defined yet. A possible impact of the patient's gender on the outcome of patients undergoing CAS has not been investigated properly and only little information about this topic is available so far.Methods:We analysed data of the German prospective, multicenter CAS Registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte.Results:From July 1996 to May 2009 5130 patients underwent CAS at 35 German hospitals and were enrolled into the prospective ALKK CAS Registry. Therefrom 1443 (28.1%) patients were female. There was no significant time‐related difference in the proportion of women undergoing CAS over the years. Women undergoing CAS were significantly older than men (73 years vs. 70 years, p < 0.01) and had a longer in hospital stay in comparison to men (p < 0.01). The majority of patients treated with CAS was between 60 and 80 years of age (∼73%). No significant differences between women and men could be found regarding in‐hospital events like death (0.5% vs. 0.5%, p = 0.99), major or minor stroke (1.7% vs. 1.6%, p = 0.97; 1.0% vs. 1.6%, p = 0.12), TIA (2.8% vs. 2.6%, p = 0.64), amaurosis fugax (0.3% vs. 0.5%, p = 0.25) , intracranial bleeding (0.5% vs. 0.3%, p = 0.43), myocardial infarction (0.1% vs. 0.0%, p = 0.48) or all non‐fatal strokes and all death (3.0% vs. 3.4%, p = 0.47). 30 day event rates did not show gender related differences in the combined endpoint of the outcome of patients undergoing CAS, as well (♀ n = 31/882 [3.5%] vs. ♂ n = 109/2273 [4.8%], p = 0.12).Conclusion:Our results do not suggest any gender‐related differences in success rates and complications in CAS. In clinical practice approximately 30% of patients treated with CAS are women.The institutions and people who participated in the ALKK CAS Registry are listed in Zahn et al.16 The authors have no funding, financial relationships, or conflicts of interest to disclose.

Asymptomatic Females Are at Higher Risk for Perioperative TIA/Stroke and Males Are at Higher Risk for Long-Term Mortality after Carotid Artery Stenting: A Vascular Quality Initiative Analysis

“…In a multicenter CAS registry in Germany in which 30% of patients treated with CAS were female, there were no significant sex differences in outcomes. 8 Similar results were reported in single-center retrospective studies in New York 9 and Italy. 10 However, in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), 11 female patients were noted to have higher risk of strokes after CAS.…”

Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings

“…Carotid artery stenting (CAS) is used as an alternative to carotid endarterectomy in treatment of carotid artery stenosis, especially in patients with high risk for surgery [1].…”