Howard Virginia J, Voeks Jenifer H, Lutsep Helmi L, Mackey Ariane, Milot Genevieve, Sam Albert D, Tom Meelee, Hughes Susan E, Sheffet Alice J, Longbottom Mary, Avery Jason B, Hobson Robert W, Brott Thomas G
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA.
Stroke. 2009 Apr;40(4):1140-7. doi: 10.1161/STROKEAHA.108.541847. Epub 2009 Feb 10.
Several carotid endarterectomy randomized, controlled trials and series have reported higher perioperative stroke and death rates for women compared with men. The potential for this same relationship with carotid artery stenting was examined in the lead-in phase of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).
CREST compares efficacy of carotid endarterectomy and carotid artery stenting in preventing stroke, myocardial infarction, and death in the periprocedural period and ipsilateral stroke over the follow-up period. CREST included a "lead-in" phase of symptomatic (>or=50% stenosis) and asymptomatic (>or=70% stenosis) patients. Patients were examined by a neurologist preprocedure, at 24 hours, and at 30 days. Review of stroke and death was by an independent events committee. The association of sex with periprocedural stroke and death was examined in 1564 patients undergoing carotid artery stenting (26.5% symptomatic).
Women comprised 37% of the lead-in cohort and did not differ from men by age, symptomatic status, or characteristics of the internal carotid artery. The 30-day stroke and death rate for women was 4.5% (26 of 579; 95% CI, 3.0% to 6.5%) compared with 4.2% (41 of 985; 95% CI, 3.0% to 5.6%) for men. The difference in stroke and death rate was not significant nor were there any significant differences by sex after adjustment for age, arterial characteristics, or cardiovascular risk factors.
These results do not provide evidence that women have a higher carotid artery stenting stroke and death rate compared with men. The potential differential periprocedural risk by sex will be prospectively addressed in the randomized phase of CREST.
多项颈动脉内膜切除术随机对照试验及系列研究报告称，女性围手术期卒中及死亡率高于男性。在颈动脉血运重建内膜切除术与支架置入术试验（CREST）的导入阶段，研究了这种关系在颈动脉支架置入术中存在的可能性。
CREST比较了颈动脉内膜切除术与颈动脉支架置入术在预防围手术期卒中、心肌梗死和死亡以及随访期同侧卒中方面的疗效。CREST包括一个针对有症状（≥50%狭窄）和无症状（≥70%狭窄）患者的“导入”阶段。术前、术后24小时及30天由神经科医生对患者进行检查。由独立事件委员会对卒中和死亡情况进行审查。对1564例行颈动脉支架置入术的患者（26.5%有症状），研究性别与围手术期卒中和死亡的相关性。
女性占导入队列的37%，在年龄、症状状态或颈内动脉特征方面与男性无差异。女性30天卒中和死亡率为4.5%（579例中的26例；95%可信区间，3.0%至6.5%），男性为4.2%（985例中的41例；95%可信区间，3.0%至5.6%）。卒中和死亡率的差异无统计学意义，在对年龄、动脉特征或心血管危险因素进行校正后，按性别也无显著差异。
这些结果并未提供证据表明女性颈动脉支架置入术的卒中和死亡率高于男性。CREST随机阶段将前瞻性地研究性别在围手术期的潜在差异风险。
