Gender differences in treatment of severe carotid stenosis after transient ischemic attack.
Gender differences in treatment of severe carotid stenosis after transient ischemic attack.
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DOI：
10.1161/strokeaha.110.580977
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发表时间：
2010-09
期刊：
影响因子：
8.3
通讯作者：
Nguyen-Huynh MN
中科院分区：
文献类型：
--
作者：
Poisson SN;Johnston SC;Sidney S;Klingman JG;Nguyen-Huynh MN
短暂性脑缺血发作（TIA）后颈动脉内膜切除术（CEA）发生率的性别差异尚未得到充分研究，尽管一些报告表明，符合条件的男性比女性更有可能在卒中后发生CEA。我们回顾性地确定了2003-2004年19个急诊科超声诊断为TIA和颈动脉狭窄≥70%的所有患者。提取医疗记录中的临床数据、90天随访事件（包括卒中、心血管事件或死亡）、6个月内CEA和术后30天结局。我们评估了性别作为CEA及其并发症的预测因子，调整了人口统计学和临床变量，以及两组之间的CEA时间。在确定的299名患者中，47%为女性。女性年龄较大，SBP较高，吸烟、CAD或糖尿病的可能性较小。女性（36.4%）CEA少于男性（53.8%）（p=0.004）。女性和男性停止手术治疗的原因相似，随访卒中、CV事件、术后并发症或死亡无差异。在女性中，CEA的时间也显著延迟。患有严重颈动脉狭窄和近期TIA的女性比男性更不可能接受CEA，手术也更延迟。
Gender differences in carotid endarterectomy (CEA) rates after transient ischemic attack (TIA) are not well studied, though some reports suggest that eligible men are more likely to have CEA than women after stroke. We retrospectively identified all patients diagnosed with TIA and ≥70% carotid stenosis on ultrasound in 2003-2004 from 19 emergency departments. Medical records were abstracted for clinical data, 90-day follow-up events including stroke, cardiovascular events or death, CEA within 6 months, and post-operative 30-day outcomes. We assessed gender as a predictor of CEA and its complications, adjusting for demographic and clinical variables, as well as time to CEA between groups. Of 299 patients identified, 47% were women. Women were older with higher presenting SBP and less likely to smoke or to have CAD or diabetes. Fewer women (36.4%) had CEA than men (53.8%) (p=0.004). Reasons for withholding surgical treatment were similar in women and men, and there were no differences in follow-up stroke, CV event, postoperative complications or death. Time to CEA was also significantly delayed in women. Women with severe carotid stenosis and recent TIA are less likely to undergo CEA than men, and surgeries are more delayed.