Division of Vascular Surgery, New York University Medical Center, New York, NY, USA.
J Vasc Surg. 2011 Jun;53(6):1457-64. doi: 10.1016/j.jvs.2011.02.029. Epub 2011 Apr 22.
The benefit of carotid endarterectomy (CEA) in female patients has been questioned by various randomized, prospective trials, particularly in asymptomatic cases; several have noted an increase in perioperative stroke among women after CEA. The outcome of carotid angioplasty and stenting (CAS) has not been extensively examined in women. This study examined the outcome of CEA and CAS in women vs men by using a national database.
Outcomes of CEA and CAS were stratified by sex using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. The NIS was used to identify patient discharges that occurred during 2004 and 2005. Appropriate International Classification of Diseases, 9th Revision (ICD-9) procedure and diagnosis codes were used to identify CEA and CAS cases. Outcome measures included in-hospital perioperative stroke and death. Comparisons of demographics, procedures, and outcome were performed between men and women. Additional analysis was performed among women alone to attempt to identify whether improved outcome was noted with either procedure.
Of 54,658 procedures, 94.2% were CEA and 5.8% were CAS. Women comprised 42.3% of the analyzed cases. Women and men were equally likely to be symptomatic (5.3% vs 5.3%, P = .8). Women were significantly less likely to undergo CAS than men (5.4% vs 6.1%, P < .001). Women and men had equivalent rates of perioperative stroke when undergoing CEA (1.0% vs 1.0%, P = .9) and CAS (2.7% vs 2.0%, P = .2). Symptomatic women had a significantly higher rate of perioperative stroke overall than did symptomatic men (3.8% vs 2.3%, P = .03). Asymptomatic women had a significantly lower perioperative stroke rate after CEA than after CAS (0.9% vs 2.1%, P < .001). Rates of perioperative showed a trend favoring CEA vs CAS among symptomatic women (3.4% vs 6.2%, P = .1).
The concern regarding an increased perioperative stroke rate after CEA among asymptomatic women appears to be unfounded. The perioperative stroke rate among symptomatic women was higher than that of symptomatic men, but still well within the acceptable range for symptomatic patients undergoing a cerebrovascular intervention. Nationally, women underwent CAS significantly less frequently than did men. Outcome among women for perioperative stroke favored CEA over CAS, particularly in asymptomatic patients. CEA may be the preferred treatment in women seeking intervention for cerebrovascular disease, unless compelling reasons exist to perform CAS.
颈动脉内膜切除术（CEA）在女性患者中的益处受到了各种随机、前瞻性试验的质疑，尤其是在无症状病例中；其中一些研究指出，CEA 后女性围手术期卒中发生率增加。颈动脉血管成形术和支架置入术（CAS）的结果在女性中尚未得到广泛研究。本研究使用国家数据库比较了女性和男性的 CEA 和 CAS 结果。
利用国家住院患者样本（NIS）、医疗保健成本和利用项目（HCUP）、医疗保健研究与质量局的数据，根据性别对 CEA 和 CAS 的结果进行分层。NIS 用于识别 2004 年和 2005 年期间发生的患者出院情况。使用适当的国际疾病分类，第 9 版（ICD-9）手术和诊断代码来识别 CEA 和 CAS 病例。观察指标包括院内围手术期卒中发生率和死亡率。对男性和女性的人口统计学、手术和结果进行了比较。对女性进行了单独的进一步分析，试图确定两种手术方法是否能改善预后。
在 54658 例手术中，94.2%为 CEA，5.8%为 CAS。女性占分析病例的 42.3%。女性和男性发生症状的可能性相同（5.3%比 5.3%，P=0.8）。与男性相比，女性接受 CAS 的可能性显著降低（5.4%比 6.1%，P<0.001）。女性和男性接受 CEA 时的围手术期卒中发生率相同（1.0%比 1.0%，P=0.9）和 CAS（2.7%比 2.0%，P=0.2）。接受 CEA 的有症状女性总体上围手术期卒中发生率明显高于有症状男性（3.8%比 2.3%，P=0.03）。无症状女性 CEA 后围手术期卒中发生率明显低于 CAS（0.9%比 2.1%，P<0.001）。有症状女性的围手术期卒中率显示 CEA 优于 CAS 的趋势（3.4%比 6.2%，P=0.1）。
无症状女性 CEA 后围手术期卒中发生率增加的担忧似乎没有根据。有症状女性的围手术期卒中发生率高于有症状男性，但仍在接受脑血管介入治疗的有症状患者的可接受范围内。在全国范围内，女性接受 CAS 的频率明显低于男性。对于围手术期卒中，女性 CEA 优于 CAS，尤其是无症状患者。对于寻求脑血管疾病干预的女性，CEA 可能是首选治疗方法，除非存在进行 CAS 的强烈理由。
