1. An Analysis of Sex-Based Outcomes Following Transcarotid Artery Revascularization.
- Author
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Husman, Regina, Tanaka, Akiko, George, Mitchell, Cambiaghi, Tommaso, Leonard, Samuel D., Motaganahalli, Raghu L., Fajardo, Andres, and Wang, S. Keisin
- Subjects
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MYOCARDIAL infarction risk factors , *HYPERTENSION risk factors , *ADVERSE health care events , *HEART failure risk factors , *THROMBOSIS risk factors , *DIABETES risk factors , *CAROTID artery surgery , *CAROTID artery , *CHRONIC kidney failure , *CRANIAL nerve diseases , *REVASCULARIZATION (Surgery) , *CAROTID endarterectomy , *AGE distribution , *RETROSPECTIVE studies , *SEX distribution , *TREATMENT effectiveness , *HYPERLIPIDEMIA , *CORONARY artery disease , *OBSTRUCTIVE lung diseases , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *POSTOPERATIVE period , *DEMOGRAPHY , *SMOKING , *BODY mass index , *ARRHYTHMIA , *LONGITUDINAL method , *DISEASE risk factors ,SURGICAL complication risk factors ,MORTALITY risk factors ,STROKE risk factors ,CAROTID artery stenosis - Abstract
Objective: 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). Methods: A retrospective review of prospectively maintained system-wide TCAR databases 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. Results: 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. In the perioperative period, there was no significant difference in reintervention rates (1.6% vs 1.2%, P =.75), cranial nerve palsy (.6% vs.4%, P >.99), ipsilateral stroke (1.9% vs 3.3%, P =.29), stent thrombosis (.4% vs.8%, P >.99), myocardial infarction (0% vs 0%, P >.99) and death (1.2% vs 1.2%, P >.99). In follow-up, no significant difference was found in reintervention, ipsilateral stroke, contralateral stroke, myocardial infarction, in-stent restenosis >50%, stent thrombosis, and death. Conclusions: 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. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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