Sex-related outcomes in asymptomatic carotid artery stenosis undergoing carotid endarterectomy

Introduction: This study aims to retrospectively analyze the perioperative and long-term outcomes of carotid endarterectomy (CEA) performed in asymptomatic patients, stratifying the results by sex. Methods: Data on CEAs performed from January 2009 to December 2020 at our institution were collected. A neurologic evaluation was conducted 30 d after surgery to assess the occurrence of neurological events. Instrumental evaluations using Doppler ultrasound were performed within the first 3 mo, at 12 mo, and annually thereafter. The primary endpoints were perioperative mortality, major neurological events, and major complications. Secondary endpoints included long-term overall survival, stroke-free survival, absence of neurological symptoms, and absence of significant (>70%) restenosis. Results: Two thousand one hundred ninety-four CEAs were performed in asymptomatic patients, with 758 females and 1436 males. There were no differences in perioperative outcomes between the two groups. In the multivariate analysis, female sex was found to be a protective factor for the risk of 30-d stroke (hazard ratio: 0.2; 95% confidence interval: 0.04-0.9; P ¼ 0.05). At a median follow-up of 24 mo, the estimated 10-y overall and strokefree survival rates were 77.6% in males versus 62.7% in females, P ¼ 0.2 and 70% in males versus 61% in females, P ¼ 0.1, respectively. Also the rates of significant restenosis did not differ between males and females (82.2% versus 87.7%, P ¼ 0.5). Conclusions: This study suggests that female sex, by itself, does not represent a risk factor for adverse outcomes after carotid surgery and it appears to be protective in the first 30 d following surgery.