The influence of female gender on the outcome of carotid endarterectomy: A challenge to the ACAS findings

Background. In the Asymptomatic Carotid Endarterectomy Study (ACAS) the perioperative stroke and mortality rate was more than twice as high in women as in men, markedly reducing the long-term benefit of the operation; therefore the role of carotid endarterectomy (CEA) among women with asymptomatic carotid stenoses remains unclear. The current study was undertaken to further examine the influence of gender on the outcome of the operation. Methods. To control for all variables except gender, the records of all patients in an academic medical center who underwent elective CEA for asymptomatic disease, performed by one surgeon employing a uniform technique, over a 7-year interval were reviewed. Results. From January 1992 through September 1998, 156 CEA procedures for asymptomatic carotid stenoses were performed on 66 (44%) women (n = 68) and 83 (56%) men (n = 88). There were no differences in the prevalence of hypertension (69 % vs 69 %), diabetes mellitus (24 % vs 19 %), hyperlipidemia (47% vs 47%), or smoking (46% vs 60%) between women and men, respectively, although a history of angina (28% vs 13%, P <.05) and myocardial infarction (23% vs 6%, P <.01) was more common among men. The mean stenosis was 86%for men and 83%for women. The incidence of perioperative mortality, stroke, and transient ischemic events was 0%, 0,6%, and 0%, with no differences between women and men: 0% vs 0%, 0% vs 1.3%, and 0% vs 0%, respectively. Conclusions. These findings indicate that female gender does not adversely influence the outcome of CEA when performed for treatment of asymptomatic disease. Gender should not be a consideration in the decision to perform CEA because of asymptomatic disease.