Carotid stenosis in women: time for a reappraisal

The treatment approach for patients with internal carotid artery stenosis is receiving increased scrutiny. Major advances in optimal medical therapy have been associated with a declining stroke rate for symptomatic and asymptomatic patients with carotid stenosis. Customising treatment according to gender is worthy of consideration, since earlier clinical trials showed reduced benefit with carotid endarterectomy in women compared to men. In this review, clinical trial results in women are summarised, studies pertaining to carotid plaque imaging in men and women are discussed and new clinical trials are identified. Finally, the rationale for a women's carotid trial is provided.