Carotid endarterectomy in women: Challenging the results from ACAS and NASCET

Mark A. Mattos, David S. Sumner, W. Todd Bohannon, Jose Parra, Robert Mclafferty, Laura A. Karch, Don E. Ramsey, Kim J. Hodgson

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objective: To evaluate and compare the short- and long-term outcomes in female and male patients after carotid endarterectomy (CEA). Summary Background Data: Randomized carotid trials have clearly shown the benefits of CEA in specific symptomatic and asymptomatic patients. However, the short- and long-term benefits in women appear to be less clear, and the role of CEA among women with carotid disease remains uncertain. Methods: During a 21 -year period, 1,204 CEAs were performed, 464 (39%) in women and 739 (61%) in men. Complete follow-up was available in 70% of patients. Results: Women were less likely to have evidence of coronary artery disease, were more likely to be hypertensive, and had a significantly greater incidence of diabetes. The mean age at CEA was 68.5±9.5 years for women and 68.0±8.5 years for men. There were no significant differences in the use of shunts, patching, tacking sutures, or severity of carotid stenoses between men and women. Surgical death rates were nearly identical for asymptomatic and symptomatic patients. Perioperative stroke rates were similar for asymptomatic and symptomatic patients. Life-table stroke-free rates at 1,5, and 8 years were similar for asymptomatic women and men and symptomatic women and men. Long-term survival rates at 1, 5, and 8 years were higher for asymptomatic women compared with men and for symptomatic women compared with men. As a result, stroke-free survival rates at these follow-up intervals were greater for asymptomatic women compared with men, and for symptomatic women compared to men. Conclusions: The results from this study challenge the conclusions from the Asymptomatic Carotid Endarterectomy Study and the North American Symptomatic Carotid Endarterectomy Trial regarding the benefits of CEA in women. Female gender did not adversely affect early or late survival, stroke-free, or stroke-free death rates after CEA. The authors conclude that CEA can be performed safely in women with asymptomatic and symptomatic carotid artery disease, and physicians should expect comparable benefits and outcomes in women and men undergoing CEA.

Original languageEnglish (US)
Pages (from-to)438-446
Number of pages9
JournalAnnals of Surgery
Volume234
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Carotid Endarterectomy
Stroke
Survival Rate
Carotid Artery Diseases
Life Tables
Mortality
Carotid Stenosis
Sutures

ASJC Scopus subject areas

  • Surgery

Cite this

Mattos, M. A., Sumner, D. S., Bohannon, W. T., Parra, J., Mclafferty, R., Karch, L. A., ... Hodgson, K. J. (2001). Carotid endarterectomy in women: Challenging the results from ACAS and NASCET. Annals of Surgery, 234(4), 438-446. https://doi.org/10.1097/00000658-200110000-00003

Carotid endarterectomy in women : Challenging the results from ACAS and NASCET. / Mattos, Mark A.; Sumner, David S.; Bohannon, W. Todd; Parra, Jose; Mclafferty, Robert; Karch, Laura A.; Ramsey, Don E.; Hodgson, Kim J.

In: Annals of Surgery, Vol. 234, No. 4, 2001, p. 438-446.

Research output: Contribution to journalArticle

Mattos, MA, Sumner, DS, Bohannon, WT, Parra, J, Mclafferty, R, Karch, LA, Ramsey, DE & Hodgson, KJ 2001, 'Carotid endarterectomy in women: Challenging the results from ACAS and NASCET', Annals of Surgery, vol. 234, no. 4, pp. 438-446. https://doi.org/10.1097/00000658-200110000-00003
Mattos, Mark A. ; Sumner, David S. ; Bohannon, W. Todd ; Parra, Jose ; Mclafferty, Robert ; Karch, Laura A. ; Ramsey, Don E. ; Hodgson, Kim J. / Carotid endarterectomy in women : Challenging the results from ACAS and NASCET. In: Annals of Surgery. 2001 ; Vol. 234, No. 4. pp. 438-446.
@article{73ede60c5b2540a987f38405ebfe76a9,
title = "Carotid endarterectomy in women: Challenging the results from ACAS and NASCET",
abstract = "Objective: To evaluate and compare the short- and long-term outcomes in female and male patients after carotid endarterectomy (CEA). Summary Background Data: Randomized carotid trials have clearly shown the benefits of CEA in specific symptomatic and asymptomatic patients. However, the short- and long-term benefits in women appear to be less clear, and the role of CEA among women with carotid disease remains uncertain. Methods: During a 21 -year period, 1,204 CEAs were performed, 464 (39{\%}) in women and 739 (61{\%}) in men. Complete follow-up was available in 70{\%} of patients. Results: Women were less likely to have evidence of coronary artery disease, were more likely to be hypertensive, and had a significantly greater incidence of diabetes. The mean age at CEA was 68.5±9.5 years for women and 68.0±8.5 years for men. There were no significant differences in the use of shunts, patching, tacking sutures, or severity of carotid stenoses between men and women. Surgical death rates were nearly identical for asymptomatic and symptomatic patients. Perioperative stroke rates were similar for asymptomatic and symptomatic patients. Life-table stroke-free rates at 1,5, and 8 years were similar for asymptomatic women and men and symptomatic women and men. Long-term survival rates at 1, 5, and 8 years were higher for asymptomatic women compared with men and for symptomatic women compared with men. As a result, stroke-free survival rates at these follow-up intervals were greater for asymptomatic women compared with men, and for symptomatic women compared to men. Conclusions: The results from this study challenge the conclusions from the Asymptomatic Carotid Endarterectomy Study and the North American Symptomatic Carotid Endarterectomy Trial regarding the benefits of CEA in women. Female gender did not adversely affect early or late survival, stroke-free, or stroke-free death rates after CEA. The authors conclude that CEA can be performed safely in women with asymptomatic and symptomatic carotid artery disease, and physicians should expect comparable benefits and outcomes in women and men undergoing CEA.",
author = "Mattos, {Mark A.} and Sumner, {David S.} and Bohannon, {W. Todd} and Jose Parra and Robert Mclafferty and Karch, {Laura A.} and Ramsey, {Don E.} and Hodgson, {Kim J.}",
year = "2001",
doi = "10.1097/00000658-200110000-00003",
language = "English (US)",
volume = "234",
pages = "438--446",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Carotid endarterectomy in women

T2 - Challenging the results from ACAS and NASCET

AU - Mattos, Mark A.

AU - Sumner, David S.

AU - Bohannon, W. Todd

AU - Parra, Jose

AU - Mclafferty, Robert

AU - Karch, Laura A.

AU - Ramsey, Don E.

AU - Hodgson, Kim J.

PY - 2001

Y1 - 2001

N2 - Objective: To evaluate and compare the short- and long-term outcomes in female and male patients after carotid endarterectomy (CEA). Summary Background Data: Randomized carotid trials have clearly shown the benefits of CEA in specific symptomatic and asymptomatic patients. However, the short- and long-term benefits in women appear to be less clear, and the role of CEA among women with carotid disease remains uncertain. Methods: During a 21 -year period, 1,204 CEAs were performed, 464 (39%) in women and 739 (61%) in men. Complete follow-up was available in 70% of patients. Results: Women were less likely to have evidence of coronary artery disease, were more likely to be hypertensive, and had a significantly greater incidence of diabetes. The mean age at CEA was 68.5±9.5 years for women and 68.0±8.5 years for men. There were no significant differences in the use of shunts, patching, tacking sutures, or severity of carotid stenoses between men and women. Surgical death rates were nearly identical for asymptomatic and symptomatic patients. Perioperative stroke rates were similar for asymptomatic and symptomatic patients. Life-table stroke-free rates at 1,5, and 8 years were similar for asymptomatic women and men and symptomatic women and men. Long-term survival rates at 1, 5, and 8 years were higher for asymptomatic women compared with men and for symptomatic women compared with men. As a result, stroke-free survival rates at these follow-up intervals were greater for asymptomatic women compared with men, and for symptomatic women compared to men. Conclusions: The results from this study challenge the conclusions from the Asymptomatic Carotid Endarterectomy Study and the North American Symptomatic Carotid Endarterectomy Trial regarding the benefits of CEA in women. Female gender did not adversely affect early or late survival, stroke-free, or stroke-free death rates after CEA. The authors conclude that CEA can be performed safely in women with asymptomatic and symptomatic carotid artery disease, and physicians should expect comparable benefits and outcomes in women and men undergoing CEA.

AB - Objective: To evaluate and compare the short- and long-term outcomes in female and male patients after carotid endarterectomy (CEA). Summary Background Data: Randomized carotid trials have clearly shown the benefits of CEA in specific symptomatic and asymptomatic patients. However, the short- and long-term benefits in women appear to be less clear, and the role of CEA among women with carotid disease remains uncertain. Methods: During a 21 -year period, 1,204 CEAs were performed, 464 (39%) in women and 739 (61%) in men. Complete follow-up was available in 70% of patients. Results: Women were less likely to have evidence of coronary artery disease, were more likely to be hypertensive, and had a significantly greater incidence of diabetes. The mean age at CEA was 68.5±9.5 years for women and 68.0±8.5 years for men. There were no significant differences in the use of shunts, patching, tacking sutures, or severity of carotid stenoses between men and women. Surgical death rates were nearly identical for asymptomatic and symptomatic patients. Perioperative stroke rates were similar for asymptomatic and symptomatic patients. Life-table stroke-free rates at 1,5, and 8 years were similar for asymptomatic women and men and symptomatic women and men. Long-term survival rates at 1, 5, and 8 years were higher for asymptomatic women compared with men and for symptomatic women compared with men. As a result, stroke-free survival rates at these follow-up intervals were greater for asymptomatic women compared with men, and for symptomatic women compared to men. Conclusions: The results from this study challenge the conclusions from the Asymptomatic Carotid Endarterectomy Study and the North American Symptomatic Carotid Endarterectomy Trial regarding the benefits of CEA in women. Female gender did not adversely affect early or late survival, stroke-free, or stroke-free death rates after CEA. The authors conclude that CEA can be performed safely in women with asymptomatic and symptomatic carotid artery disease, and physicians should expect comparable benefits and outcomes in women and men undergoing CEA.

UR - http://www.scopus.com/inward/record.url?scp=0034785529&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034785529&partnerID=8YFLogxK

U2 - 10.1097/00000658-200110000-00003

DO - 10.1097/00000658-200110000-00003

M3 - Article

C2 - 11573037

AN - SCOPUS:0034785529

VL - 234

SP - 438

EP - 446

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 4

ER -