Postoperative complications following carotid endarterectomy are differentially impacted by sex and plaque...

This study aimed to provide novel evidence on the role of sex and plaque instability in post-carotid endarterectomy outcomes. Current clinical guidelines regarding recommendation for carotid endarterectomy rely solely on grade of stenosis and cerebrovascular symptomatology, despite emerging evidence emphasizing the role of sex and plaque instability in determining postoperative outcomes.

We conducted a retrospective analysis of an ongoing cohort study of males and females undergoing carotid endarterectomy for clinical indications. We performed multivariable binary logistic regression to examine the relationship of biological sex and plaque instability with postoperative outcomes.

Data of 394 participants (31% female) were analyzed. Plaque instability was independently associated with decreased odds of hemorrhagic complications at 1 month and 1 year post-surgery, as well as with decreased respiratory complications at 1 year post-surgery. Plaque features accounting for these associations were lipid core, cap infiltration, and plaque inflammation. Female sex was independently associated with increased odds of restenosis at 1 month and 1 year post-surgery. Additionally, females with unstable plaques had more cerebrovascular complications at 1 month than males with unstable plaques, and females with stable plaques had double the odds of any complication at 1 month compared with males with unstable plaques.

Our findings show that sex and plaque instability differentially impact post-endarterectomy outcomes, with males with unstable plaques experiencing the least postoperative complications. Sex and plaque instability may therefore be important factors that play a role in postoperative complications, highlighting their importance in the context of surgical decision-making.