Stroke, or cerebral vascular accident (CVA), is the fifth leading cause of death in the United States, causing 160,264 deaths in 2020 [1]. This morbid condition is associated with high health care costs, significant functional disability, and early mortality. Atherosclerotic plaque at the carotid artery bifurcation is one of the primary treatable causes of future stroke; it is estimated that 10% to 15% of all CVAs may be attributable to stenosis of the internal carotid artery [2]. Severe or symptomatic stenosis may be treated with carotid artery interventions, including carotid endarterectomy (CEA) or stenting procedures (transfemoral carotid artery stenting [tf-CAS] and transcarotid artery revascularization [TCAR]). Seminal studies of CEA performed in the 1990s suggested poorer perioperative outcomes in female patients, leading to decreased efficacy in stroke prevention in female patients. However, more recent trials and multiple institutional database studies have not always reported similar results [3], [4], [5]. There is extensive literature on the topic of sex-specific outcomes after carotid intervention, with widely varying results reported. Compounding the challenges in interpreting this literature, female patients have been underrepresented nearly universally.

Examining sex differences in outcomes after carotid artery interventions is a crucial step toward improving outcomes in female patients and reducing potential disparities of care. Incorporating sex-specific risk assessment tools, diagnostic criteria, and treatment algorithms into clinical practice can enhance the accuracy and effectiveness of health care interventions.

We conducted a systematic review to identify sex-specific differences in outcomes after carotid artery interventions (ie, CEA, tf-CAS, and TCAR).