An Analysis Of Sex Based Outcomes Following Transcarotid Artery Revascularization
Regina Husman, MD, S. Keisin Wang, Samuel D. Leonard, MD, Akiko Tanaka, MD, Mitchell George, MD, Tommaso Cambiaghi.
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
OBJECTIVES: Several studies suggest that females have higher perioperative adverse events and decreased benefit from carotid artery revascularization with transfemoral carotid artery stenting and carotid endarterectomy (CEA) compared to males. However, there are limited data of sex-based outcomes for transcarotid artery revascularization (TCAR). This investigation was performed to evaluate gender-based outcomes with TCAR.
METHODS: A retrospective review of prospectively maintained system-wide TCAR databases from two institutions was performed between December 2015-January 2022. Patients who underwent TCAR were stratified based on sex. Relevant demographics, medical conditions, anatomical characteristics, intra- and postoperative courses, and adverse events were captured for statistical analysis.
RESULTS: In all, 729 patients underwent TCAR, 486 (66.6%) male and 243 (33.3%) female. Males were more likely to be diagnosed with coronary artery disease (56.9% vs. 47.7%, P<.01) and were active smokers (30.4% vs. 21.4%, P<.01). Age, symptomatic status, BMI, hypertension, hyperlipidemia, diabetes mellitus, arrhythmia, chronic obstructive pulmonary disease, history of myocardial infarction, heart failure with reduced ejection fraction <30%, end-stage renal disease and Charlson Comorbidity Index were similar between the two cohorts. In the perioperative period, there was no significant difference in reintervention rates (1.6% vs. 1.2%, P=.75), cranial nerve palsy (0.6% vs. 0.4%, P>.99), ipsilateral stroke (1.9% vs. 3.3%, P=.29), stent thrombosis (0.4% vs. 0.8%, P>.99), myocardial infarction (0% vs. 0%, P>.99) and death (1.2% vs. 1.2%, P>.99). In the follow-up interval, no significant difference was found in reintervention, ipsilateral stroke, contralateral stroke, myocardial infarction, in-stent restenosis >50%, stent thrombosis, and death.
CONCLUSIONS: In our study, males and females did not have a statistically significant difference in outcomes when comparing ipsilateral stroke, in-stent thrombosis, conversion to CEA, and death after TCAR. However, our cohort comprised predominantly male patients and may conceal statistical significance as the females in our cohort did have a higher tendency toward developing complications. Future studies with a larger female cohort should be conducted to determine whether there is a true disparity of outcomes between the males and females undergoing TCAR.
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