Sex-related differences in embolic potential during carotid angioplasty and stenting.

Background: Carotid angioplasty and stenting (CAS) is an alternative to carotid endarterectomy. CAS outcomes and risk factors affecting postoperative complications in women are not well defined. We sought to determine the effect of sex on particle size captured by embolic protection devices, comorbidities influencing embolization, and results after CAS.

Methods: Embolic debris from 188 consecutively collected carotid embolic protection devices were analyzed using photomicroscopy and imaging software. Patient comorbidities, preoperative cerebrovascular symptoms, and perioperative outcomes (cerebrovascular accident, myocardial infarction, mortality) were examined.

Results: The mean age was 71.0 years (56.4% males). Men (M) were more likely than women (W) to be smokers (M: 70.4% vs. W: 55.6%, p = 0.046) and have coronary artery disease (M: 65.7% vs. W: 48.1%, p = 0.02). Symptomatic (S) patients had larger mean particle size compared with asymptomatic (AS) patients (S: 469.9 ± 416.4 μm vs. AS: 316.1 ± 241.1 μm, p = 0.01). On subgroup analysis, a larger mean particle size was observed in symptomatic woman compared with asymptomatic women (S: 461.5 ± 348.1 μm vs. AS: 281.4 ± 209.4 μm, p = 0.02). In men, a trend toward a larger mean particle size in symptomatic patients did not reach statistical significance (S: 475.8 ± 462.9 μm vs. AS: 351.2 ± 262.4 μm, p = 0.08).

Conclusions: Preoperative cerebrovascular symptoms are associated with a greater mean particle size in symptomatic women compared with asymptomatic women. This difference in mean particle size was not observed in men. These results provide evidence that may help in better selection of CAS patients, but the impact of an increased mean particle size in symptomatic women during carotid stenting requires further investigation.