Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200169
Jornal Vascular Brasileiro
Original Article

Carotid artery stenting has similar outcomes in men and women

Implante de stent na artéria carótida tem desfechos semelhantes em homens e mulheres

Marina Ansuategui; Gabriela Ibarra; Carmen Romero; Alejandra Comanges; Jose A. Gonzalez-Fajardo

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Abstract

Abstract: Background: The aim of carotid interventions is to prevent cerebrovascular events. Endovascular treatment (carotid-artery-stenting/CAS) has become established as an alternative to open surgery in some cases. Historically, female sex has been considered as a perioperative risk factor, however, there are few studies regarding this hypothesis when it comes to CAS.

Objectives: To analyze the CAS results in our center adjusted by sex.

Methods: A retrospective cohort study was designed, including patients with carotid atheromatosis operated at a single center from January 2016 to June 2019. Our objective was to compare cardiovascular risk, including myocardial infarction, stroke, and mortality, by sex. Follow-up rates of stent patency, restenosis, stroke, myocardial infarction, and death were reported.

Results: 71 interventions were performed in 50 men (70.42%) and 21 women (29.57%). Mean age was 70.50 ± 10.72 years for men and 73.62 ± 11.78 years for women. Cardiovascular risk factors did not differ significantly between sexes. Mean follow-up was 11.28 ± 11.28 months. There were no significant differences in neurological events during follow-up. No adverse cardiological events were detected at any time. Regarding the mortality rate, during medium-term follow up there were 2 neurological related deaths with no significant differences between sexes (p=0.8432). Neither sex had higher rated of restenosis during long term follow-up (5.63% vs. 1.41%, p = 0.9693) or reoperation (1.41% vs. 1.41%, p = 0.4971). All procedures remained patent (<50% restenosis).

Conclusions: Despite the limitations of our study, CAS is a therapeutic option that is as effective and safe in women as in men. No sex differences were observed.

Keywords

carotid artery stenting-female, complications, mortality, restenosis

Resumo

Resumo: Contexto: As intervenções carotídeas visam prevenir eventos cerebrovasculares. O tratamento endovascular (implante de stent na artéria carótida) se estabeleceu como uma alternativa à cirurgia aberta em alguns casos. Historicamente, o sexo feminino é considerado um fator de risco perioperatório, mas há poucos estudos abordando essa hipótese em casos de stent de carótida.

Objetivos: Analisar os resultados do CAS em nosso centro ajustados por sexo.

Métodos: Este estudo de coorte retrospectivo incluiu pacientes com ateromatose carotídea operados em um centro de janeiro de 2016 a junho de 2019. Nosso objetivo foi comparar o risco cardiovascular, incluindo infarto do miocárdio, acidente vascular cerebral e mortalidade, de acordo com o sexo. No seguimento, foram descritos patência do stent, reestenose, acidente vascular cerebral, infarto do miocárdio e morte.

Resultados: Setenta e uma intervenções foram realizadas: 50 homens (70,42%) e 21 mulheres (29,57%). A média de idade foi de 70,50 ± 10,72 anos nos homens e 73,62 ± 11,78 anos nas mulheres. Os fatores de risco cardiovascular não diferiram significativamente entre os sexos. A média de seguimento foi de 11,28 ± 11,28 meses. Durante o seguimento, não houve diferenças significativas nos eventos neurológicos. Nenhum evento cardiológico adverso foi detectado. Quanto à taxa de mortalidade, durante o seguimento de médio prazo ocorreram 2 óbitos neurológicos sem diferenças significativas entre os sexos (p = 0,8432). Não foi observada maior taxa de reestenose no seguimento de longo prazo (5,63% vs. 1,41%, p = 0,9693) ou de reoperação (1,41% vs. 1,41%, p = 0,4971) ao comparar os dois sexos. Todos os procedimentos permaneceram pérvios (< 50% de reestenose).

Conclusões: Apesar das limitações deste estudo, o stent de carótida em mulheres é uma opção terapêutica tão eficaz e segura quanto em homens. Nenhuma diferença foi observada entre os sexos.
 

Palavras-chave

stent de carótida-feminino, complicações, mortalidade, reestenose

References

1 Yadav J, Wholey M, Kuntz R, et al. Protected carotid artery stenting versus endaerterectomy in high risk patients. N Engl J Med. 2004;351(15):1493-501. http://dx.doi.org/10.1056/NEJMoa040127. PMid:15470212.

2 Karpenko A, Starodubtsev V, Ignatenko P, et al. Comparative Analysis of Carotid Artery Stenting and Carotid Endarterectomy in Clinical Practice. J Stroke Cerebrovasc Dis. 2020;29(5):104751. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104751. PMid:32160955.

3 Bond R, Rerkasem K, Cuffe R, Rothwell PM. A systematic review of the associations between age and sex and the operative risks of carotid endarterectomy. Cerebrovasc Dis. 2005;20(2):69-77. http://dx.doi.org/10.1159/000086509. PMid:15976498.

4 Dulai M, Tawfick W, Hynes N, Sultan S. Female Gender as a Risk Factor for Adverse Outcomes After Carotid Revascularization. Ann Vasc Surg. 2019;60:254-63. http://dx.doi.org/10.1016/j.avsg.2019.03.007. PMid:31200032.

5 den Hartog AG, Algra A, Moll FL, et al. Mechanisms of gender-related outcome differences after carotid endarterectomy. J Vasc Surg. 2010;52:71.e1-6.

6 Luebke T, Brunkwall J. Meta- analysis and meta-regression analysis of the associations between sex and the operative outcomes of carotid endarterectomy. BMC Cardiovasc Disord. 2015;15(1):32. http://dx.doi.org/10.1186/s12872-015-0029-x. PMid:25956903.

7 Mayor JM, Salemi JL, Dongarwar D, et al. Sex-Based Differences in Ten-Year Nationwide Outcomes of Carotid Revascularization. J Am Coll Surg. 2019;229(1):38-46.e4. http://dx.doi.org/10.1016/j.jamcollsurg.2019.02.054. PMid:30922980.

8 Paraskevas KI, Kalmykov EL, Naylor AR. Stroke/death rates following carotid artery stenting and carotid endarterectomy in contemporary administrative dataset registries: a systematic review. Eur J Vasc Endovasc Surg. 2016;51:3e12.

9 Strandness DE Jr. Duplex scanning in vascular disorders. New York: Raven Press; 1993.

10 Torres Blanco A, Cuenca Manteca J. Guías de diagnóstico de la enfermedad cerebrovascular extracraneal. Angiología. 2020;72(2): 94-110.

11 North American Symptomatic Carotid Endarterectomy Trial C. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445e53.

12 Naylor AR, Ricco J-B, de Borst GJ, et al. Editor’s choice e management of atherosclerotic carotid and vertebral artery disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):55. http://dx.doi.org/10.1016/j.ejvs.2017.06.021.

13 Liapis CD, Bell PR, Mikhailidis D, et al. ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009;37(Suppl. 4):1e19.

14 Appelros P, Stegmayr B, Terent A. Sex differences in stroke epidemiology: a systematic review. Stroke. 2009;40(4):1082-90. http://dx.doi.org/10.1161/STROKEAHA.108.540781. PMid:19211488.

15 Bisdas T, Egorova N, Moskowitz AJ, et al. The impact of gender on in-hospital outcomes after carotid endarterectomy or stenting. Eur J Vasc Endovasc Surg. 2012;44:244e250.

16 Bennett KM, Scarborough JE. Carotid artery stenting is associated with a higher incidence of major adverse clinical events than carotid endarterectomy in female patients. J Vasc Surg. 2017;66:794e801.

17 Jim J, Dillavou ED, Upchurch GR Jr, et al, and the SVS Outcomes Committee. SVS Outcomes Committee Gender-specific 30 day outcomes after carotid endarterectomy and carotid artery stenting in the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2014;59(3):742-8. http://dx.doi.org/10.1016/j.jvs.2013.09.036. PMid:24246542.

18 Goldstein LJ, Khan HU, Sambol EB, Kent KC, Faries PL, Vouyouka AG. Carotid artery stenting is safe and associated with comparable outcomes in men and women. J Vasc Surg. 2009;49(2):315-24. http://dx.doi.org/10.1016/j.jvs.2008.08.110. PMid:19216949.

19 Casana R, Malloggi C, Tolva VS, et al. Three-year outcomes after carotid artery revascularization: Gender-related differences. Vascular. 2019;27(5):459-67. http://dx.doi.org/10.1177/1708538119836312. PMid:30860445.
 


Submitted date:
09/07/2020

Accepted date:
01/20/2021

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