The Impact of Sex on Outcomes following Carotid Endarterectomy

Previous studies have demonstrated significant sex differences in vascular surgery outcomes. We assessed stroke or death rates following carotid endarterectomy (CEA) in women versus men.The Vascular Quality Initiative was used to identify all patients who underwent CEA between 2010 and 2019. Demographic, clinical, and procedural characteristics were recorded and differences between women and men were assessed using independent t-test and chi-squared test. The primary outcomes were 30-day and 1-year stroke or death. Associations between sex and outcomes were assessed using univariate/multivariate logistic regression and Cox proportional hazards analysis.Overall, 52,137 women and 79,974 men underwent CEA in Vascular Quality Initiative sites during the study period. Women were younger (70.3 vs. 70.5 years, P < 0.001) and more likely to have hypertension (89.2% vs. 88.9%, P < 0.05) and diabetes (36.2% vs. 35.8%, P < 0.001) but less likely to be diagnosed with coronary artery disease (23.2% vs. 31.0%, P < 0.001). A greater proportion of men were receiving cardiovascular risk reduction medications and had symptomatic carotid stenosis (28.5% vs. 26.7%, P < 0.001). Women had shorter procedure times (113 vs. 122 min, P < 0.001) and were less likely to receive electroencephalography neuromonitoring (27.9% vs. 28.8%, P < 0.001), drain (35.9% vs. 37.3%, P < 0.001), and protamine (67.4% vs. 68.0%, P < 0.01). Stroke or death at 30 days (1.9% vs. 1.8%, P = 0.60) and 1 year (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.94-1.01, P = 0.20) were similar between groups, which persisted in asymptomatic patients (HR 0.97, 95% CI 0.93-1.01, P = 0.17) and symptomatic patients (HR 0.99, 95% CI 0.93-1.05, P = 0.71). The similarities in 1-year stroke or death rates existed in both the United States (HR 0.96, 95% CI 0.92-1.01, P = 0.09) and Canada (HR 1.21, 95% CI 0.47-3.11, P = 0.70).Despite sex differences in clinical and procedural characteristics, women and men have similar 30-day and 1-year outcomes following CEA.