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Sex differences in patients with symptomatic carotid stenosis included in three observational cohorts

Kremer, Christine LU ; Carcel, Cheryl and Johansson, Elias (2026) In European Stroke Journal 11(4). p.1-9
Abstract

INTRODUCTION: Sex differences in symptomatic carotid artery stenosis have been reported with conflicting results, with knowledge gaps regarding the degree of carotid stenosis, management and preoperative ischaemic events. This study aimed to determine sex differences in symptomatic carotid artery stenosis prior to undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS).

PATIENTS AND METHODS: This was a secondary analysis using pooled data from 3 cohorts with recent symptomatic ≥ 50% carotid artery stenosis undergoing preoperative evaluation for possible CEA or CAS.

RESULTS: The cohorts included 934 participants (mean age 73 years); 299 (32%) were women. Women underwent CEA or CAS less often (66% vs 73%; P =... (More)

INTRODUCTION: Sex differences in symptomatic carotid artery stenosis have been reported with conflicting results, with knowledge gaps regarding the degree of carotid stenosis, management and preoperative ischaemic events. This study aimed to determine sex differences in symptomatic carotid artery stenosis prior to undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS).

PATIENTS AND METHODS: This was a secondary analysis using pooled data from 3 cohorts with recent symptomatic ≥ 50% carotid artery stenosis undergoing preoperative evaluation for possible CEA or CAS.

RESULTS: The cohorts included 934 participants (mean age 73 years); 299 (32%) were women. Women underwent CEA or CAS less often (66% vs 73%; P = .026), which was not significant after adjustment for the degree of stenosis (P = .17). The number of carotid near-occlusions (CNOs) was comparable (31% women vs 32% men, P = .93). Women without CNO more often had 50%-69% stenosis (67% vs 55%, P = .029) and smaller internal carotid artery (ICA) diameters (4.0 mm vs 4.2 mm, P < .001). Women with CNO more often had full collapse (42% vs 25%, P = .011). The risk of preoperative ischaemic events did not differ.

DISCUSSION AND CONCLUSION: There were significant sex differences in the degree of stenosis and anatomy of the ICA, potentially explaining why fewer women underwent CEA/CAS. No sex differences in the risk of preoperative early stroke recurrence were found.

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Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Carotid Stenosis/surgery, Female, Male, Aged, Endarterectomy, Carotid, Stents, Sex Factors, Cohort Studies, Aged, 80 and over, Middle Aged
in
European Stroke Journal
volume
11
issue
4
article number
aakag018
pages
1 - 9
publisher
SAGE Publications
external identifiers
  • pmid:42012818
ISSN
2396-9881
DOI
10.1093/esj/aakag018
language
English
LU publication?
yes
additional info
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Stroke Organisation.
id
78c27c58-f0a9-4a0f-a70b-14d80a6e693c
date added to LUP
2026-04-25 13:41:20
date last changed
2026-04-27 08:23:52
@article{78c27c58-f0a9-4a0f-a70b-14d80a6e693c,
  abstract     = {{<p>INTRODUCTION: Sex differences in symptomatic carotid artery stenosis have been reported with conflicting results, with knowledge gaps regarding the degree of carotid stenosis, management and preoperative ischaemic events. This study aimed to determine sex differences in symptomatic carotid artery stenosis prior to undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS).</p><p>PATIENTS AND METHODS: This was a secondary analysis using pooled data from 3 cohorts with recent symptomatic ≥ 50% carotid artery stenosis undergoing preoperative evaluation for possible CEA or CAS.</p><p>RESULTS: The cohorts included 934 participants (mean age 73 years); 299 (32%) were women. Women underwent CEA or CAS less often (66% vs 73%; P = .026), which was not significant after adjustment for the degree of stenosis (P = .17). The number of carotid near-occlusions (CNOs) was comparable (31% women vs 32% men, P = .93). Women without CNO more often had 50%-69% stenosis (67% vs 55%, P = .029) and smaller internal carotid artery (ICA) diameters (4.0 mm vs 4.2 mm, P &lt; .001). Women with CNO more often had full collapse (42% vs 25%, P = .011). The risk of preoperative ischaemic events did not differ.</p><p>DISCUSSION AND CONCLUSION: There were significant sex differences in the degree of stenosis and anatomy of the ICA, potentially explaining why fewer women underwent CEA/CAS. No sex differences in the risk of preoperative early stroke recurrence were found.</p>}},
  author       = {{Kremer, Christine and Carcel, Cheryl and Johansson, Elias}},
  issn         = {{2396-9881}},
  keywords     = {{Humans; Carotid Stenosis/surgery; Female; Male; Aged; Endarterectomy, Carotid; Stents; Sex Factors; Cohort Studies; Aged, 80 and over; Middle Aged}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{4}},
  pages        = {{1--9}},
  publisher    = {{SAGE Publications}},
  series       = {{European Stroke Journal}},
  title        = {{Sex differences in patients with symptomatic carotid stenosis included in three observational cohorts}},
  url          = {{http://dx.doi.org/10.1093/esj/aakag018}},
  doi          = {{10.1093/esj/aakag018}},
  volume       = {{11}},
  year         = {{2026}},
}