Surgical treatment of carotid artery to prevent stroke less effective in women

New research suggests that women are at higher risk for stroke and have different stroke symptoms than men. Furthermore, they benefit less from a surgery used to treat carotid artery disease, a key risk factor for stroke.

"Men and women are different and sometimes their disease might call for a different treatment approach," said the study's lead investigator Niveditta Ramkumar, a graduate student at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire. "Because our study found women are getting more strokes than men, it may mean their treatment, in this case, endarterectomy, is not as effective in women as it is in men."

The preliminary study, which used data on 31,207 people age 65 and older with carotid artery disease, will be presented Sunday at the American Heart Association's Scientific Sessions in Philadelphia.

In the U.S., about 795,000 people have a stroke each year. It is the fifth-leading cause of death in the country.

There are different types of strokes. An ischemic stroke occurs when the blood flow to a part of the brain is blocked. The carotid arteries are the blood vessels on either side of the neck that carry blood to the brain and face. Carotid artery disease causes about 15 per cent of all ischemic strokes.

Risk factors for carotid artery disease include getting older, smoking, high blood pressure, high cholesterol, diabetes and lack of exercise.

The degree of buildup inside the arteries determines treatment options. About 5 per cent of people who have fatty deposits filling up 70 per cent or more of their carotid arteries will have a stroke within five years.

If blood flow is only slightly restricted, people are often treated with medications to control contributing factors like high cholesterol or high blood pressure. If the blockage is severe, surgery to remove the plaque is recommended. An endarterectomy is typically the preferred option, Ramkumar said.

"We have seen in studies over and over again that gender plays a role in carotid artery disease," said Dr Dorothea Altschul, a neurointerventional surgeon in New Jersey who was not involved with the research.

"But we are at a loss to figure out how to guide medical management," she said. "We know that the composition of the plaque that narrows the arteries is different in women. But we don't know if women should have different options than men."

Ramkumar said she hopes the findings from her research lead to increased efforts to have at least 50 per cent of the participants in cardiology clinical trials be women.

"Biological sex needs to be at the forefront of our understanding of the effects of these treatments and their long-term outcomes," she said.

Abstract 15874: Women Have a Higher 5-Year Risk of Stroke After Intervention for Carotid Stenosis Than Men