Safety of Carotid Revascularization during the Acute Period of Neurological Symptom Onset in Women

Background Benefit from carotid revascularization is supposed to be lower in women due to increased periprocedural risks. The aim of this study was to investigate the risk of stroke/death after carotid intervention in women treated within 15 days from last neurological event. Methods Data from 282 consecutive patients treated during 2009–2015 by carotid endarterectomy or carotid stenting within 15 days from neurological symptoms were analyzed by sex and stratified according to treatment delay toward symptoms onset. Results Eighty women (28.4%) underwent carotid stenosis correction: in 37 treatment was performed within 7 days from symptoms (in 12 within 48 hr); the remaining underwent carotid disease correction between day 8 and day 15 after the index event. Baseline comorbidity profile, presenting symptoms (stroke, transient ischemic attack, and recurrent symptoms) and treatment delay were comparable between sexes. The 30-day stroke/death rate was 2.5% in women (2/80) and 3.5% (7/202) in men (P = 1.00). There was no 30-day death or cerebral hemorrhage in women and in patients treated within the first 48 hours. In adjusted analyses, female sex was not associated with increased stroke/death risk. At 4 years, for women and men survival was 93.9% vs. 79.2% (P = 0.047) and freedom from stroke 92.6% vs. 92.2% (P = 0.76). Conclusions Women with symptomatic carotid stenosis may benefit as men from intervention when performed within the acute (15 days) or hyperacute (48 hr) period after neurological event. Thirty-day stroke/death rate in this experience is lower or comparable to men's and treatment appears to be effective in preventing new strokes at midterm.