The Role of Gender in Carotid Artery Stenting: A Single-Center Experience

Objectives: Carotid artery stenting (CAS) is a well-documented alterna- tive technique for the treatment of carotid stenosis. Large randomized clinical trials showed carotid endoarterectomy is less favorable for symp- tomatic women than men and less or not beneficial for asymptomatic women because of a higher periprocedural risk of stroke and death. CREST did not show any differences between genders in CAS. The aim of our study was to evaluate the early and long-term Results of CAS at our institution, focusing our attention on gender results Methods: A total of 487 consecutive CAS procedures were performed from January 2006 to September 2018 in our center. We treated 345 men (71%) and 142 women (29%) with both symptomatic and asymp- tomatic carotid stenosis. Our median length of follow-up is 46 months. Our postoperative surveillance was performed with clinical and Duplex ultrasound examination at 1, 6, and 12 months after the procedure and then yearly. Statistical analysis was performed by SPSS software (SPSS Inc., Chicago, Ill). Results: The 30-day stroke rate was similar in both group (1/345 in male patients versus 0/142 in women; P ¼ NS; Fig). Our median follow-up was 46 months. During this period, we recorded three other strokes in men and two strokes in women, not related to CAS (three were hemorrhagic strokes). In addition, 17 deaths occurred: 1 male patient at the 30-day follow-up died (stroke-related death) and no women died; thereafter, 11 men died and 5 women died (mortality for all causes). Kaplan-Meier curves showed similar survival and stroke-free survival rates in both groups (log-rank test, 0.7; P ¼ NS). Conclusions: Our data show CAS is safe and effective also in women, with a low incidence of intraoperative and postoperative strokes and with a good overall survival in long-term follow-up