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© 2009 American Academy of Neurology Gender differences in carotid imaging and revascularization following strokeFrom the Departments of Medicine (M.K.K., F.L.S., G.S.) and Health Policy, Management and Evaluation (M.K.K., G.S.), University of Toronto, Toronto; Institute for Clinical Evaluative Sciences (M.K.K., J.F., D.J.G., A.R.), Toronto; Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.) and Division of Neurology (F.L.S.), University Health Network, Toronto; Division of Neurology (D.J.G.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Stroke Research Unit (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital; Department of Medicine (M.B.-Y.), McGill University, Montreal; and Canadian Stroke Network (M.B.-Y., F.L.S., J.F., A.R., M.K.K.), Canada. Address correspondence and reprint requests to Dr. Moira K. Kapral, Toronto General Hospital, 200 Elizabeth St., 14 Eaton North, Room 215, Toronto, Ontario, Canada M5G 2C4 moira.kapral{at}ices.on.ca Background: Carotid endarterectomy is performed less often in women than in men, but it is unknown whether this reflects differences in screening rates, disease prevalence, or other factors. Methods: This was a cohort study of consecutive patients with acute stroke or TIA admitted to 11 Ontario stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003, and September 30, 2007. We compared rates of carotid imaging, the severity of carotid stenosis, and rates of carotid endarterectomy or angioplasty within 6 months of the index event in women vs men. Results: We studied 6,389 patients (48% women) with ischemic stroke or TIA. Women were less likely than men to undergo carotid imaging (81% vs 86%, p < 0.0001); however, when the analysis was limited to patients without apparent contraindications to surgery, 92% received carotid imaging, with no difference between women and men. Women were less likely than men to have severe carotid stenosis (7.4% vs 11.5%, p < 0.0001). Women were half as likely as men to undergo carotid revascularization within 6 months of the index event (odds ratio 0.51, 95% confidence interval 0.37 to 0.70), but this gender difference was no longer significant in the subgroup with severe carotid stenosis (odds ratio 0.75, 95% confidence interval 0.49 to 1.15). Conclusions: Although women with ischemic stroke or TIA are less likely than men to undergo carotid screening and revascularization, this difference is largely explained by potential contraindications to surgery and by sex differences in the severity of carotid disease.
Abbreviations: CI = confidence interval; OR = odds ratio; RCSN = Registry of the Canadian Stroke Network.
This work was funded by an operating grant from the Canadian Stroke Network. The Registry of the Canadian Stroke Network is funded by the Canadian Stroke Network and the Ontario Ministry of Health and Long-Term Care. The Institute for Clinical Evaluative Sciences is supported by an operating grant from the Ontario Ministry of Health and Long-Term Care. The results and conclusions are those of the authors, and should not be attributed to any of the sponsoring or funding agencies. The funding agencies had no role in the design or conduct of the study or the collection, management, analysis, or interpretation of the data. The manuscript was reviewed and approved by the publications committee of the Registry of the Canadian Stroke Network. Disclosure: Author disclosures are provided at the end of the article. Received April 27, 2009. Accepted in final form September 17, 2009.
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