Is female gender really a risk factor for carotid endarterectomy?

The aim of this study was to assess the effect of gender on mortality and morbidity in carotid endarterectomy (CEA) patients.

Forty-one female and 150 male patients who underwent isolated CEA operations, between 1994 and 2007, were included in this study. To find the role of gender in isolated CEA operations, patients with a previous history of cardiac operations, coronary interventions, and a staged cardiac and/or vascular operation were excluded from the study.

In the postoperative period, one female patient (2.4%) and 8 male patients (4.9%) had neurological complications (p > 0.05). Hospital mortality rates of female and male groups were 0.0% and 2.4%, respectively (p > 0.05). Perioperative events which cause significant increase in hospital mortality were myocardial ischemia, low cardiac output, and need of intra-aortic balloon pump (p = 0.0001). Late mortality rates of female and male groups were 7.5% and 9.9%, respectively. The actuarial survival rate was 82.2 +/- 11.6% in women and 71.5 +/- 7.5% in men for a mean period of 36.4 +/- 29.1 months (p > 0.05). All the observed mortalities in the long term were cardiac-related or with other causes, no neurological deaths observed in both groups (p > 0.05). According to logistic regression analysis smoking and peripheral arterial disease were found as statistically significant risk factors for late mortality.

Female gender is not a risk factor for stroke or death after CEA. Women should not be excluded from the benefits of CEA and gender should not be a consideration in the decision to perform it.