Gender differences in carotid imaging and revascularization following stroke
M K Kapral1, M Ben-Yakov, J Fang
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada. moira.kapral@ices.on.ca
Neurology
|December 10, 2009
Summary
Women with ischemic stroke or TIA undergo less carotid screening and revascularization than men. This difference is mainly due to contraindications for surgery and less severe carotid stenosis in women.
Area of Science:
- Neurology
- Vascular Surgery
- Epidemiology
Background:
- Carotid endarterectomy rates are lower in women than men.
- Reasons for this disparity, including screening and disease prevalence, are unclear.
Purpose of the Study:
- To investigate gender differences in carotid imaging, stenosis severity, and revascularization after ischemic stroke or TIA.
- To determine if disparities in treatment are explained by patient factors or disease characteristics.
Main Methods:
- A cohort study of 6,389 patients with ischemic stroke or TIA across 11 Ontario stroke centers.
- Comparison of carotid imaging rates, stenosis severity, and endarterectomy/angioplasty rates between women and men within 6 months of the event.
Main Results:
- Women were less likely to undergo carotid imaging (81% vs 86%) and have severe stenosis (7.4% vs 11.5%).
- Women were half as likely to undergo revascularization (OR 0.51).
- Gender differences in revascularization were not significant in patients with severe stenosis.
Conclusions:
- Women with ischemic stroke or TIA receive less carotid screening and revascularization compared to men.
- Disparities are primarily attributed to surgical contraindications and sex-based differences in carotid disease severity.
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