You'll want a guarantee from your doctors that neither procedure will have any negative consequences for you. In my non-medical opinion I can see no reason to do either of these procedures if the Circle of Willis is complete and you just have your doctor close the offending artery.
Female Gender Increases Risk of Stroke and Readmission after CEA(Carotid endarterectomy) and CAS(carotid artery stenting)
Published:November 01, 2021DOI:https://doi.org/10.1016/j.jvs.2021.10.034
ABSTRACT
Objectives
Carotid endarterectomy (CEA) has historically demonstrated a higher rate of perioperative
adverse events for female patients. However, recent evidence suggests similar outcomes
for CEA between genders. In contrast, fewer studies have examined gender in carotid
artery stenting (CAS). Using contemporary data from the American College of Surgeons
(ACS) National Surgical Quality Improvement Program (NSQIP) database, we aim to determine
if gender impacts differences in postoperative complications in patients who undergo
CEA or CAS.
Methods
The ACS NSQIP database was queried from 2005-2017 using Current Procedural Terminology
(CPT) and International Classification of Diseases (ICD) codes for retrospective review.
Patients with carotid intervention (CEA or CAS) were stratified into asymptomatic
vs symptomatic cohorts to determine the effect of gender on 30-day postoperative outcomes.
Symptomatic patients were defined as those with perioperative transient cerebral ischemic
attack or stenosis of carotid artery with cerebral infarction. Descriptive statistics
were calculated. Risk-adjusted odds of 30-day postoperative outcomes were calculated
using multivariate regression analysis with fixed effects for age, race, and comorbidities.
Results
There were 106,568 patients with CEA or CAS (104,412 CEA and 2,156 CAS). Average age
was 70.9 years old and female patients accounted for 39.9% of the population. For
asymptomatic patients that underwent CEA or CAS, female gender was associated with
significantly higher rates of CVA/stroke (13%, p=0.005), readmission (10%, p=0.004),
bleeding complication (32%, p=0.001), and UTI (54%, p=0.001) as well as less infection
(26%, p=0.001). In the symptomatic cohort, female gender was associated with significantly
higher rates of CVA/stroke (32%, p=0.034), bleeding complication (203%, p=0.001),
and UTI (70%, p=0.011), while female gender was associated with a lower rate of pneumonia
(39%, p=0.039). Subset analysis found that, compared to male patients, female patients
<75yo have an increased rate of CVA/stroke (21%, p=0.001) and readmission (15%, p<0.001),
while female patients ≥75yo did not. In asymptomatic and symptomatic patients that
underwent CEA, female gender was associated with significantly higher rates of CVA/stroke
(13%, p=0.006 and 31%, p=0.044, respectively), but this finding was present not in
patients undergoing CAS.
Conclusion
In patients undergoing carotid intervention, female gender was associated with significantly
increased rates of postoperative CVA/stroke in the asymptomatic and symptomatic cohorts
as well as readmission in the asymptomatic cohort. Female gender was associated with
higher rates of CVA/stroke following CEA, but not CAS. We recommend that randomized
control trials ensure adequate representation of female patients to better understand
gender-based disparities in carotid intervention.
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