Carotid artery stenting may pose higher risk for women than men

Carotid artery stenting may carry a higher periprocedural risk of stroke for women than carotid endarterectomy, but the same difference in risk apparently doesn’t hold for men, according to a new study from the University of Alabama at Birmingham School of Public Health.

A prespecified secondary analysis of data from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) examined differences in periprocedural risks between the 2 procedures by sex. Periprocedural events occurred in 35 (4.3%) of 807 men who underwent carotid stenting compared with 40 (4.9%) of 823 men who underwent carotid endarterectomy. Among women, 31 (6.8%) of 455 who underwent stenting experienced a periprocedural event compared with 16 (3.8%) of 417 who underwent endarterectomy. Women had a higher risk of periprocedural stroke after stenting than endarterectomy, whereas stroke risk didn’t differ by procedure in men.

The study was published online May 9 in Lancet Neurology.

“These results suggest that the possibility of an increased periprocedural risk of stroke in women after carotid artery stenting should be taken into account when selecting treatment for carotid artery disease,” the authors write. However, they would not rule out stenting for women based on the study results, says lead author Virginia J Howard, PhD. Rather, the findings should be considered in the overall context of risks for a particular patient.

The researchers acknowledge that “subgroup analyses can lead to spurious findings,” but note that they followed published criteria to protect against that happening. They also note that although “CREST included a targeted recruitment goal for women to provide sufficient statistical power to test for interaction,” the study’s sample sizes “were too small to further subdivide by symptomatic status, age, and other important clinical predictors.” Future clinical trials “should aim to enroll a larger number of women,” they write.