Neurological Sciences

, Volume 34, Issue 10, pp 1711–1717

Age and gender disparities in the risk of carotid revascularization procedures

  • Sotirios Giannopoulos
  • Aristeidis H. Katsanos
  • Spyros N. Vasdekis
  • Efstathios Boviatsis
  • Konstantinos Ι. Voumvourakis
  • Georgios Tsivgoulis
Review Article

DOI: 10.1007/s10072-013-1453-2

Cite this article as:
Giannopoulos, S., Katsanos, A.H., Vasdekis, S.N. et al. Neurol Sci (2013) 34: 1711. doi:10.1007/s10072-013-1453-2

Abstract

The potential effect of age and gender stratification in the outcome of patients with carotid artery stenosis undergoing carotid revascularization procedures (CRP) may have important implications in clinical practice. Both European Stroke Organization and American Heart Association guidelines suggest that age and sex should be taken into account when selecting a CRP for an individual patient. We reviewed available literature data through Medline and Embase. Our search was based on the combination of terms: age, gender, sex, carotid artery stenosis, carotid artery stenting (CAS) and carotid endarterectomy (CEA). Postoperative stroke and mortality rates increased with age after any CRP (CEA or CAS), especially in patients aged over 75 years. Older patients with carotid artery stenosis undergoing CAS were found to have a nearly double risk of stroke or death compared with CEA, while CEA was found to benefit more patients aged over 70 years with symptomatic carotid artery stenosis. Male patients with symptomatic or asymptomatic carotid artery stenosis had lower stroke/mortality rates and benefited more from CEA compared with females. For the periprocedural risk of stroke or death in patients with carotid artery stenosis after CAS no sex differences were found. Therefore, CEA appears to have lower perioperative risks than CAS in patients aged over 70 years, and thus should be the treatment of choice if not contraindicated. The periprocedural risk of CEA is lower in men than in women, while there was no effect of gender on the periprocedural risk of CAS.

Keywords

AgeGenderDisparitiesCarotid endarterectomyCarotid artery stenting

Abbreviations

RCT

Randomized clinical trial

CEA

Carotid endarterectomy

CAS

Carotid artery stenting

ACST

Asymptomatic carotid surgery trial

ECST

European carotid surgery trial

NASCET

North American symptomatic carotid endarterectomy trial

VACSP

Veterans affairs cooperative studies program

CREST

Carotid revascularization versus stenting trial

EVA-3S

Endarterectomy versus angioplasty in patients with severe symptomatic carotid stenosis

SPACE

Stent-protected angioplasty versus carotid endarterectomy

ICSS

International carotid stenting study

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Sotirios Giannopoulos
    • 1
  • Aristeidis H. Katsanos
    • 1
  • Spyros N. Vasdekis
    • 2
  • Efstathios Boviatsis
    • 3
  • Konstantinos Ι. Voumvourakis
    • 4
  • Georgios Tsivgoulis
    • 4
    • 5
  1. 1.Department of Neurology University of Ioannina School of MedicineIoanninaGreece
  2. 2.Vascular Unit, Third Department of Surgery, School of MedicineUniversity of AthensAthensGreece
  3. 3.Second Department of Neurosurgery, School of MedicineUniversity of AthensAthensGreece
  4. 4.Second Department of Neurology, School of MedicineUniversity of AthensAthensGreece
  5. 5.International Clinical Research CenterSt. Anne’s University HospitalBrnoCzech Republic