Abstract Background and aims Sex differences in symptomatic carotid stenosis (symCS) have been in the focus of research. There is a lack of data regarding degree of carotid stenosis, management, and preoperative ischemic events. This study aimed to determine these sex differences in symCS prior to carotid endarterectomy (CEA) or carotid artery stenting (CAS). Methods Secondary analysis of pooled data from three cohorts with recent symptomatic ≥50% carotid artery stenosis undergoing preoperative evaluation for potential CEA or CAS. Results Of 934 participants (mean age 73 y), 299 (32%) were women. Women were less frequently referred from other hospitals (76% vs. 82%, p=0.043), a difference that remained statistically significant after adjustment in two multivariable models (p=0.025; p=0.0503). Women underwent CEA or CAS less frequently (66% vs. 73%; p=0.026), not statistically significant after adjusting for the degree of stenosis (p=0.17). Carotid near-occlusions (CNO) were similar between sexes (24% women vs. 26% men, p=0.52). Women more frequently showed 50-69% stenosis (57% vs. 45%, p=0.005) and had smaller ICA diameters (4.0 vs. 4.2 mm, p 0.001). Among women with CNO, full collapse was more prevalent (42% vs. 26%, p=0.015). The risk of preoperative ischemic events did not differ between sexes. Conclusions This pooled analysis showed that women were less frequently referred for CEA/CAS evaluation compared to men, even after adjusting for relevant confounders. Significant sex differences were observed in the degree of stenosis and the anatomy of the ICA, which may account for the lower percentage of CEA/CAS in women. The risk of preoperative ischemic events was comparable. Conflict of interest Christine Kremer has received research funding from Strokeförbundet, Sweden and speaker honoraria from Ferrer LATAM. Cheryl Carcel holds an investigator grant from the National Health and Medical Research Council of Australia. She receives honoraria for Advisory Board Activities with Bayer. Elias Johansson is an editorial board member of the European Stroke Journal and otherwise has no potential conflicts of interest with respect to research, authorship and/or publication of this article.
Kremer et al. (Fri,) studied this question.