Effect of age and gender on restenosis after carotid endarterectomy

Several studies have suggested that the benefits of CEA may be gender-dependent. The purpose of this study was to focus on age and gender outcomes after CEA. Three hundred seventy-two CEAs were performed in 344 patients (115 females, 229 males; mean age 72.9 years). Mean follow-up was 25.8 months. Data were collected retrospectively by chart review, and follow-up data were obtained by clinical examination and duplex ultrasound. Recurrent stenosis was defined as >50% and/or occlusion. Three hundred and seventy-two CEAs were performed in 120 female and 252 male carotid arteries: 97.3% of patients underwent patch angioplasty (bovine pericardium 71.5%, Dacron 21.8%, vein 3.8%, and polytetrafluoroethylene 0.3%) and 2.7% of patients underwent eversion endarterectomy. Perioperative mortality rate (30-day) was 0.8% (0% of females vs. 1.2% of males), and stroke rate was 0.5% (1.7% of females vs. 0% of males), with no significant gender difference (p = 0.554 and p = 0.103, respectively). Follow-up ultrasound revealed 21 (7%) restenoses (>50%) and/or occlusions, with a significantly higher rate of restenosis in females (14% vs. 3.9% in males, p = 0.008) and in patients <70 years of age at time of surgery (p = 0.003). There was no age difference between women and men with restenosis. Although there was no statistical difference in occurrence of restenosis between Dacron and bovine patch (p = 0.62), females who underwent patch angioplasty with Dacron were more likely to develop restenosis (p = 0.052). CEA is a low-risk procedure for significant carotid stenosis; however, females are more likely to develop restenosis after carotid surgery, especially with Dacron patches. Younger patients appear to be at a higher risk of restenosis after surgery.