Compared with men, women have smaller-caliber internal carotid arteries and shorter stenotic segments.425,426 CEA is also performed less often in women, likely because of the lower incidence of high-grade symptomatic stenosis.427,428 In a retrospective cohort study at Kaiser Permanente Medical Care Plan, for the period 2003 to 2004, 299 patients were identified on the basis of a diagnosis of TIA and carotid stenosis (>70%), that is, symptomatic stenosis.427 Approximately half (47%) were women. Women were less likely to undergo CEA (36.4% versus 53.8% in men; P=0.004). Being female remained an independent predictor for not receiving CEA after adjust- ment for age, number of TIAs, specificity of TIA symptoms, and degree of stenosis. In patients who underwent CEA, the time to surgery was longer in women (mean of 35 days) than men (mean of 18 days; P=0.03),427 whereas the current recommendations are to perform CEA within 2 weeks of symptoms of TIA or mild stroke.20 In the surgical subgroup, women were older and less likely to have coronary artery disease. Outcomes were similar in men and women in both the CEA and medical management groups.427 In subgroup analyses of some trials comparing medi- cal management to CEA in patients with symptomatic or asymptomatic carotid stenosis, women appeared to derive less benefit from surgery than men, potentially because of an increased risk of perioperative events411 413 ; however, the data were inconclusive because of small sample sizes within sex strata and the post hoc nature of some of the analyses. 