In Reply Multiple retrospective series have identified female sex as a risk factor for perioperative stroke and death after carotid endarterectomy (CEA).1 An international consensus,2 as discussed by De Rango and colleagues, states that “according to the currently available literature, cardiovascular screening, risk factor control, and optimization of medical therapy should be intensified for all women with symptomatic or asymptomatic carotid stenosis.” However, international differences in practice must be reviewed. Dr Cambria’s recent article states that “the data indicate that for symptomatic patients, CEA is the preferred treatment strategy in virtually all patient populations…in addition, best medical therapy would only be a logical treatment alternative in patients with comorbid conditions expected to limit their longevity to less than a year. The SVS [Society for Vascular Surgery] knows of no data that would indicate that specific sex, or racial/ethnic background would have a material impact on the above conclusions.”3(p6) This statement is a testament to the differences in the management of carotid stenosis around the world.
Kuy S, Dua A. Uncertainty in Management of Carotid Stenosis in Women—Reply. JAMA Surg. 2014;149(4):402–403. doi:10.1001/jamasurg.2013.4867