Percutaneous intervention for infrageniculate arterial disease in women may be associated with better outcomes when compared to men.

OBJECTIVE: The purpose of this study was to identify any gender-associated differences in the percutaneous treatment of infrageniculate lesions in individuals with chronic critical limb ischemia. METHODS: A retrospective chart review was performed on 112 index tibial lesions in 81 consecutive patients operated on from January 2005 to February 2011. All patients were treated for critical limb ischemia-defined as rest pain or tissue loss. Patient demographics, comorbidities, clinical presentation, vascular studies, lesion characteristics, procedures, and postoperative complications were entered into a database for review. Patients were evaluated for primary patency, secondary patency, limb salvage, and mortality rates. RESULTS: Sixty-three index tibial lesions were treated percutaneously in 43 women, compared to 49 lesions in 38 men. There was a trend toward increased cardiac disease (65.8% men vs 44.2% women; P = .052) and smoking (52.6% men vs 32.6% women; P = .070) in men. Men were more likely than women to have TransAtlantic Inter-Society Consensus (TASC) C and D lesions (83.7% vs 65.1%; P = .023) and to be treated for total occlusion (44.9% vs 25.4%; P = .031). There were no significant gender-related differences in length of stay or postoperative complications. Women had statistically better primary patency rates than men at 12 and 24 months (77.5% ± 6.9% and 72.9% ± 7.8% in women vs 58.7% ± 9.3% and 45.2% ± 9.9% in men; P = .032). Women also had statistically better secondary patency rates than men at 12 and 24 months (90.4% ± 4.8% and 85.1% ± 6.8% in women vs 76.0% ± 8.1% and 58.5% ± 10.8% in men; P = .028). Female gender remained an independent predictor of superior patency even after controlling for gender-related differences in TASC grade. There were no significant differences in limb salvage rates at 12 and 24 months (92.1% ± 4.4% and 85.0% ± 7.9% in women vs 88.3% ± 6.4% and 83.4% ± 7.7% in men; P = .985). Overall survival rates were similar (59.8% ± 7.6% for women and 68.0% ± 8.1% for men at 24 months; P = .351). CONCLUSIONS: Percutaneous intervention may be an equally effective or better treatment option for women with chronic limb ischemia and tibial disease when compared to men. In this study, male gender was an independent predictor of poorer primary and secondary patency rates after infrageniculate intervention. There were no differences in postoperative wound complications between genders. Endovascular procedures may lessen the gap in gender-related treatment outcomes and postoperative complications seen after open arterial reconstructions.

Comparing the embolic potential of open and closed cell stents during carotid angioplasty and stenting.

OBJECTIVE: We sought to determine the effects of open (O) and closed (C) cell stents on the size and number of embolic particles generated during carotid artery stenting (CAS) and assess the impact on outcome. METHODS: Embolic debris from carotid filters after CAS was analyzed using photomicroscopy and imaging software. Patient comorbidities, preoperative cerebrovascular symptoms, stent type, and outcomes (perioperative major adverse events) were examined. RESULTS: Carotid filters from 173 consecutive CAS procedures (O, 125 and C, 48) were reviewed. The mean age was 70.9 ± 9.2 years; 58% were men. Mean stenosis was 88.2% ± 8.1%; 36.6% had neurological symptoms preprocedurally. There was no difference in preoperative symptoms between the two groups (O, 38.7% vs C, 31.3%; P = not significant [NS]). However, closed cell stent use was associated with higher degree of stenosis (O, 87.2% ± 8.0% vs C, 90.6% ± 7.8%; P = .01), an older age (O, 70.0 ± 8.6 years vs C, 73.4 ± 10.2 years; P = .03), and peripheral arterial disease (21.1% vs 43.5%; P = .01). A larger mean particle size was observed in patients treated with open cell stents compared to closed cell stents (O, 416.5 ± 335.7 µm vs C, 301.1 ± 251.3 µm; P = .03). There was no significant difference in the total number of particles (O, 13.8 ± 21.5 vs C, 17.6 ± 19.9; P = NS), periprocedural stroke (P = NS), and major adverse events between the two groups (P = NS). CONCLUSIONS: Open cell stents are associated with a larger mean particle size compared to closed cell stents. No impact on procedural outcomes based on stent type was observed.

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.