Sex differences in patients with symptomatic carotid stenosis included in three observational cohorts

Sex differences in symptomatic carotid artery stenosis have been reported with conflicting results, with knowledge gaps regarding the degree of carotid stenosis, management and preoperative ischaemic events. This study aimed to determine sex differences in symptomatic carotid artery stenosis prior to undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS).

This was a secondary analysis using pooled data from 3 cohorts with recent symptomatic ≥ 50% carotid artery stenosis undergoing preoperative evaluation for possible CEA or CAS.

The cohorts included 934 participants (mean age 73 years); 299 (32%) were women. Women underwent CEA or CAS less often (66% vs 73%; P = .026), which was not significant after adjustment for the degree of stenosis (P = .17). The number of carotid near-occlusions (CNOs) was comparable (31% women vs 32% men, P = .93). Women without CNO more often had 50%-69% stenosis (67% vs 55%, P = .029) and smaller internal carotid artery (ICA) diameters (4.0 mm vs 4.2 mm, P < .001). Women with CNO more often had full collapse (42% vs 25%, P = .011). The risk of preoperative ischaemic events did not differ.

There were significant sex differences in the degree of stenosis and anatomy of the ICA, potentially explaining why fewer women underwent CEA/CAS. No sex differences in the risk of preoperative early stroke recurrence were found.