Only 1 trial, the Asymptomatic Carotid Surgery Trial, conducted a prespecified secondary analysis by sex Although for all the subgroup analyses, the results were similar to that first found in the Asymptomatic Carotid they were statistically significant only for the European Carotid Surgery Trial, but this was a post hoc analysis.411 CEA Versus Carotid Artery Stenting Carotid artery stenting (CAS) has emerged as an alternative strategy for the management of carotid stenosis.414 416,429,430 In a meta-analysis of 3 European trials comparing CEA to CAS in symptomatic patients, there was no interaction between sex and 120-day outcome.431 The North American Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) assigned 2502 patients with symptomatic and asymptomatic carotid stenosis to either CEA or CAS. Roughly 35% (n=872) of the subjects were women. Rates of stroke, MI, or death of any cause during the periprocedural period or any ipsilateral stroke within 4 years after random- ization for CAS compared with CEA were 6.2% versus 6.8% Periprocedural events (from randomization to 30 days after the procedure) occurred in 4.3% of 807 men versus 6.8% of 455 women assigned to CAS and 4.9% of 823 men versus 3.8% of 417 women assigned to CEA, with significant interaction The CAS-to-CEA treatment difference was also affected by age (P=0.02), with older patients faring bet- ter with CEA and younger patients faring better with CAS.433 There was no evidence (P=0.45) that this effect by age was different for women than men. Although data from CREST suggest that women with CAS (relative to CEA) may be at higher risk for the composite outcome of stroke, death, or MI during the periprocedural period, this finding should be inter- preted with caution pending confirmation from other trials. 