Vascular Surgery, The Poly Clinic, Seattle, Wash.
Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
J Vasc Surg. 2019 Apr;69(4):1121-1128. doi: 10.1016/j.jvs.2018.08.152. Epub 2018 Oct 6.
The benefit for carotid endarterectomy (CEA) to prevent a potential stroke has been shown to be less beneficial for women compared with men and the risk of carotid stenting (CAS) is higher in women than men. We hypothesized that a community-based Washington state registry data would also reveal increased morbidity and mortality for women undergoing carotid interventions.
Deidentified data for CEA and CAS between 2010 and 2015 were obtained from 19 hospitals participating in the Washington State Vascular-Interventional Surgical Care and Outcomes Assessment Program. Data analysis compared in-hospital composite outcome of stroke and mortality from CEA and CAS between women and men.
Over the study period, 3704 individuals underwent CEA (n = 2759; 49.5% symptomatic) and CAS (n = 945; 60.9% symptomatic). Women accounted for 39.5% of the cohort. Women were slightly younger than men (70.0 ± 10.2 vs 71.0 ± 9.6 years respectively; P < .01), less likely to be smokers (70.1% vs 75.6%; P < .01), and less likely to have a diagnosis of coronary artery disease (32.9% vs 46.5%; P < .01). Fewer women underwent CEA for symptomatic carotid disease (46.1% vs 51.8%; P < .01). There were no statistically significant differences in the postoperative in-hospital stroke and mortality among women and men undergoing CEA (asymptomatic, 0.8% vs 1.4% [P = .36]; symptomatic, 1.8% vs 2.2% [P = .58]) and CAS (asymptomatic, 1.4% vs 2.2% [P = .56]; symptomatic, 4.6% vs 2.5% [P = .18]). Hospital duration of stay and discharge disposition were similar for women and men. A subanalysis of the octogenarian cohort undergoing CAS demonstrated a substantial increase in-hospital stroke and mortality among women and men (11.6% [CAS] vs 2.2% [CEA]; P = .024).
In the Washington state Vascular-Interventional Surgical Care and Outcomes Assessment Program registry, hospital composite outcome of stroke and mortality following carotid interventions from 2010 to 2015 were noted to be similar for women and men. The notable exception to this finding was observed in subcohort of women undergoing CAS for symptomatic carotid disease at age 80 years or older. These findings should be taken into account when risk stratifying patients for carotid interventions.
颈动脉内膜切除术（CEA）预防潜在中风的益处已被证明对女性的益处小于男性，而女性颈动脉支架置入术（CAS）的风险高于男性。我们假设，基于社区的华盛顿州注册数据也将显示女性接受颈动脉介入治疗的发病率和死亡率更高。
从参与华盛顿州血管介入手术护理和结局评估计划的 19 家医院获得 2010 年至 2015 年期间 CEA 和 CAS 的匿名数据。数据分析比较了女性和男性接受 CEA 和 CAS 后住院期间的中风和死亡率复合结局。
在研究期间，3704 人接受了 CEA（n=2759；49.5%为症状性）和 CAS（n=945；60.9%为症状性）。女性占队列的 39.5%。女性比男性略年轻（分别为 70.0±10.2 岁和 71.0±9.6 岁；P<.01），吸烟率较低（分别为 70.1%和 75.6%；P<.01），冠状动脉疾病诊断率较低（分别为 32.9%和 46.5%；P<.01）。较少的女性因症状性颈动脉疾病而行 CEA（分别为 46.1%和 51.8%；P<.01）。接受 CEA 的女性和男性在术后住院期间的中风和死亡率没有统计学上的显著差异（无症状，0.8%和 1.4%[P=0.36]；症状性，1.8%和 2.2%[P=0.58]）和 CAS（无症状，1.4%和 2.2%[P=0.56]；症状性，4.6%和 2.5%[P=0.18]）。女性和男性的住院时间和出院情况相似。对接受 CAS 的 80 岁或以上高龄患者亚组的进一步分析表明，女性和男性在住院期间的中风和死亡率均显著升高（11.6%[CAS]和 2.2%[CEA]；P=0.024）。
在华盛顿州血管介入手术护理和结局评估计划登记处，2010 年至 2015 年期间接受颈动脉介入治疗后中风和死亡率的住院综合结果，女性和男性之间没有明显差异。这一发现的一个明显例外是，在年龄在 80 岁或以上因症状性颈动脉疾病而接受 CAS 的女性亚组中观察到的结果。在对颈动脉介入治疗的患者进行风险分层时，应考虑这些发现。
