Women are at more than double the short-term risk of stroke after carotid stenting compared with traditional surgery to remove the inner lining of the diseased blood vessel, a study of the two procedures for clearing the blocked neck artery suggests.
However, little difference in stroke risk was found between the procedures in men, suggesting a patient’s gender should be considered when carotid disease treatment options are being weighed.
The findings, published online Monday in the Lancet Neurology, were part of the CREST trial, which was was established to compare the safety and effectiveness of endarterectomy (surgery) and carotid stenting in patients who suffered a minor stroke or had a narrowing of the carotid artery. The study, funded by the National Institutes of Health, looked at 2,502 patients in the United States and Canada over eight years.
Initial results showed that the overall safety and efficacy of the two interventions were similar, although more heart attacks were noted in the surgical group and more strokes in the stenting group.
In the study looking at gender differences, Virginia Howard from the University of Alabama and Thomas Brott from the Mayo Clinic in Florida found that in the first 30 days following the procedures, stroke, heart attack, and death were more frequent in women who had stenting than in those who had surgery (6.8 percent vs. 3.8 percent), whereas the rates were similar after the two procedures in men (4.3 percent vs. 4.9 percent).
The greater difference between men and women was a significantly higher likelihood of stroke in women after stenting compared with surgery (5.5 percent vs. 2.2 percent). The risk of stroke after surgery did not significantly differ by procedure in men (3.3 percent vs. 2.4 percent).
“This study adds to previous findings by showing a higher periprocedural risk from carotid artery stenting in women,” the authors said. “This additional information supports that the sex of the patients should be taken into account in decisions for treatment of carotid disease.”
In a commentary, Martin Brown and Rosalind Raine from University College London, London, cautioned that the findings are not likely due to differences in sex chromosomes, and that future study should focus on other possible risk factors.
“The choice of treatment between the sexes therefore requires better understanding of the various predictors of risk,” they wrote. “Future work needs to concentrate on identifying these risk factors to select which of carotid stenting, carotid endarterectomy, or optimized medical therapy are most appropriate for which women and which men.”
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