Carotid artery stenting is associated with a higher incidence of major adverse clinical events than carotid endarterectomy in female patients

Background: The optimal approach to carotid revascularization in female patients with carotid artery stenosis is widely debated. Information available is largely derived from clinical trials that include only highly selected patients. The goal of this study was to compare the early clinical outcomes in women who undergo carotid artery stenting (CAS) vs carotid endarterectomy (CEA). Methods: Female patients undergoing CAS or CEA between January 1, 2012 and December 31, 2015, and who were included in the Procedure Targeted American College of Surgeons National Surgical Quality Improvement Program were assessed for their incidence of early postoperative complications. The primary outcome measure was 30-day incidence of a major adverse clinical event (MACE; defined as death, stroke, transient ischemic attack, or myocardial infarction/arrhythmia). Univariable analyses were used to compare results between female patients undergoing CEA and those undergoing CAS. Propensity score matching techniques were used to create a cohort of 125 CAS and CEA patients who were well matched for all known patient-, disease-, and procedure-related factors. Analysis of comparative outcomes between the propensity-matched groups was then performed. Results: The overall study population consisted of 5620 female CEA patients and 131 female CAS patients. Of these patients, 290 (5.2%) from the CEA group and 16 (12.2%) from the CAS group sustained a MACE in the first 30 days after their procedures. Within the propensity-matched cohort, the 30-day incidence of postoperative MACE in the CAS group of this cohort was 11.2% (14 patients) compared with 4.0% (5 patients; odds ratio, 1.01 [95% confidence interval, 1.01-7.77]; P = .04) in the CEA group. Conclusions: Our analysis of a "real-world" clinical registry suggests that CAS may be inferior to CEA in female patients who require carotid artery revascularization. (J Vasc Surg 2017;66:794-801.)