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J Thorac Cardiovasc Surg 2004;127:322-324
© 2004 The American Association for Thoracic Surgery

Editorial

Outcome of carotid endarterectomy on the basis of patient sex: Is there a difference?

^a Division of TCV Surgery, University of Virginia Health System, Charlottesville, Va, USA
^b Division of Vascular Surgery, University of Maryland, Baltimore, Md, USA
^c Department of Vascular Surgery, the Cleveland Clinic Foundation, Cleveland, Ohio, USA
^d Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md, USA
^e Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn, USA

Received for publication September 29, 2003; accepted for publication October 6, 2003.

^* Address for reprints: Vivian Gahtan, MD, SUNY Upstate Medical University College of Medicine, Department of Surgery, 750 East Adams St, Syracuse, NY 13210 , USA
gahtanv@upstate.edu

The first 20% of the full text of this article appears below.

In the United States 700,000 strokes occur each year, and these are the third leading cause of death.¹ Of the 167,661 deaths from stroke reported by the American Heart Association in 2000, 102,892 were among women and 64,769 were among men.¹ Women (53%) in the United States are reported to experience strokes more frequently than men but at a more advanced age.¹ When examining sex differences, the prevalence of stroke must be controlled for age because women have a longer life expectancy, and the occurrence of stroke increases dramatically with increasing age. In the year 2000 the age-adjusted first-event stroke rates (per 100,000) were as follows: 167 for white men, 138 for white women, 323 for African American men, and 260 for African American women. Age-standardized mortalities for ischemic stroke were higher for women age 65 years and older from 1995 through 1998.¹ Most (61%) strokes are reported to be caused by atherothrombotic events.¹ Atherosclerosis and stenosis of the carotid arteries are known clinical entities associated with stroke. The overall prevalence of carotid stenosis in patients who experience ischemic strokes, however, remains unknown.

Most aspects regarding carotid endarterectomy (CEA) for stroke prevention have been examined. Patient eligibility, surgical indications, technical considerations, and detailed outcome expectations have been defined. Unfortunately, most of this scientific effort has assumed that men and women have no significant difference in outcome after CEA or the natural history of carotid stenosis. Challenges to this assumption have been raised. The Asymptomatic Carotid Atherosclerosis Study,² in 1995, sparked a debate that continues. The purpose of the study was to compare medical and . . . [Full Text of this Article]