May 9th, 2011

Higher Periprocedural Risk for Stroke Found in Women Undergoing Carotid Stenting

The periprocedural risk for stroke is higher among women undergoing carotid artery stenting than among those undergoing carotid endarterectomy, according to new results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) published online in the Lancet Neurology. The same pattern was not found in men.

Last year, the main results from CREST showed no overall difference in the primary endpoint of death, stroke, or MI within 4 years after either stenting or endarterectomy, although a higher rate of stroke was found with stenting while a higher MI rate was found with endarterectomy.

In the new analysis, there was no significant difference in the primary endpoint in either men or women:

  • men: 6·2% for stenting versus 6·8% for endarterectomy, HR 0·99, CI 0·66-1·46
  • women: 8·9% versus 6·7%, HR 1·35, CI 0·82-2·23

However, in the periprocedural period (within 30 days after the procedure), women – but not men – who were assigned to stenting had a higher risk for events:

  • men: 4·3% versus 4·9%, HR 0·90, CI 0·57-1·41
  • women: 6·8% versus 3·8%, HR 1·84, CI 1·01-3·37

This difference appeared to be largely caused by an imbalance in the risk for periprocedural stroke:

  • men: HR 1.39, CI 0.78-2.48, p=0.26
  • women: HR 2.63, CI 1.23-5.65, p=0.013

In an accompanying comment, Martin Brown and Rosalind Raine write that “any differential effects of treatment by sex are unlikely to be explained by differences in sex chromosomes. Far more likely is that other patient characteristics are the true determinants of risk difference.”

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