The influence of gender on complications of carotid endarterectomy

Purpose: Carotid endarterectomy (CEA) effectively reduces stroke risk in properly selected patients. Subgroup analysis of the Asymptomatic Carotid Artery Study trial noted increased complications in women. Additional studies implicate female gender as a risk factor for perioperative stroke, leading some clinicians to modify the indications for CEA in women. The purpose of this study was to determine the influence of gender on the risk of perioperative complications in patients undergoing CEA. Methods: The records of all patients who underwent CEA at a university medical center from January 1995 to December 1999 were reviewed. Patient demographics, procedure related risk factors, operative details, and specific complications were entered into a database for statistical analysis. Results: A total of 324 consecutive patients underwent CEA during the study period. There were 199 men (61%) and 125 women (39%). Among the men and women, there were no differences in age, smoking, hypertension, hypercholesterolemia, diabetes, family history, renal insufficiency, or symptomatic versus asymptomatic indications for CEA. More women than men received a carotid patch (90.4% versus 77.9%, P = 0.003). One woman died (0.8%) and no men died for a total combined 30-day mortality of 0.31% (P = not significant). Men and women did not differ in rates of stroke (1.5% versus 2.4%) or perioperative myocardial infarction (1.0% versus 0.8%). In addition, there was no difference when stroke and death rates were combined (2% versus 3.2%). The length of stay (2.2 versus 2.6 days) was also not different. Conclusions: There are no significant differences in rate of stroke, myocardial infarction, or 30-day mortality, between men and women following CEA. Women should not be excluded from the benefits of CEA based on perceived increased complication rates.