{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:50:29Z","timestamp":1792093829462,"version":"4.4.0"},"reference-count":41,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000156","name":"Quebec Research Fund Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000156","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004411","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["annalsofvascularsurgery.com","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Annals of Vascular Surgery"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.avsg.2026.10.007","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:14:59Z","timestamp":1791990899000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative complications following carotid endarterectomy are differentially impacted by sex and plaque instability"],"prefix":"10.1016","author":[{"given":"Alvin","family":"Kuate Defo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Gasbarrino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4774-2549","authenticated-orcid":false,"given":"Stella S.","family":"Daskalopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.avsg.2026.10.007_bib1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/17474930211065917","article-title":"World Stroke Organization (WSO): Global Stroke Fact Sheet 2022","volume":"17","author":"Feigin","year":"2022","journal-title":"Int J Stroke"},{"key":"10.1016\/j.avsg.2026.10.007_bib2","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1056\/NEJM199108153250701","article-title":"Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis","volume":"325","author":"Barnett","year":"1991","journal-title":"N Engl J Med"},{"key":"10.1016\/j.avsg.2026.10.007_bib3","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1161\/01.CIR.91.2.566","article-title":"Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association","volume":"91","author":"Moore","year":"1995","journal-title":"Circulation"},{"key":"10.1016\/j.avsg.2026.10.007_bib4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ejvs.2022.04.011","article-title":"Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease","volume":"65","author":"Naylor","year":"2023","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.avsg.2026.10.007_bib5","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.3174\/ajnr.A7223","article-title":"Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement","volume":"42","author":"Saba","year":"2021","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.1016\/j.avsg.2026.10.007_bib6","doi-asserted-by":"crossref","first-page":"4150","DOI":"10.1093\/eurheartj\/ehaf614","article-title":"ESC consensus statement on stroke risk management in carotid atherosclerotic disease: 10 key points","volume":"46","author":"Musialek","year":"2025","journal-title":"Eur Heart J"},{"key":"10.1016\/j.avsg.2026.10.007_bib7","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1161\/STROKEAHA.121.035386","article-title":"Carotid Interventions for Women: The Hazards and Benefits","volume":"53","author":"Rockman","year":"2022","journal-title":"Stroke"},{"key":"10.1016\/j.avsg.2026.10.007_bib8","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1093\/eurheartj\/ehab756","article-title":"Importance of sex and gender in ischaemic stroke and carotid atherosclerotic disease","volume":"43","author":"Gasbarrino","year":"2022","journal-title":"Eur Heart J"},{"key":"10.1016\/j.avsg.2026.10.007_bib9","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1161\/CIRCRESAHA.114.302721","article-title":"Mechanisms of plaque formation and rupture","volume":"114","author":"Bentzon","year":"2014","journal-title":"Circ Res"},{"key":"10.1016\/j.avsg.2026.10.007_bib10","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.1016\/j.wneu.2018.09.013","article-title":"Efficacy of Carotid Endarterectomy for Mild (<50%) Symptomatic Carotid Stenosis with Unstable Plaque","volume":"121","author":"Kashiwazaki","year":"2019","journal-title":"World Neurosurg"},{"key":"10.1016\/j.avsg.2026.10.007_bib11","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1016\/j.jvs.2020.10.084","article-title":"A systemic review into carotid plaque features as predictors of restenosis after carotid endarterectomy","volume":"73","author":"Zhou","year":"2021","journal-title":"J Vasc Surg"},{"key":"10.1016\/j.avsg.2026.10.007_bib12","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1161\/STROKEAHA.120.030228","article-title":"Expression of Resistin, Chemerin, and Chemerin's Receptor in the Unstable Carotid Atherosclerotic Plaque","volume":"52","author":"Yanofsky","year":"2021","journal-title":"Stroke"},{"key":"10.1016\/j.avsg.2026.10.007_bib13","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.jvs.2016.03.423","article-title":"Plaque echodensity and textural features are associated with histologic carotid plaque instability","volume":"64","author":"Doonan","year":"2016","journal-title":"J Vasc Surg"},{"key":"10.1016\/j.avsg.2026.10.007_bib14","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1161\/01.ATV.20.5.1177","article-title":"Natural history and histological classification of atherosclerotic lesions: an update","volume":"20","author":"Stary","year":"2000","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"10.1016\/j.avsg.2026.10.007_bib15","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1161\/01.CIR.0000144307.82502.32","article-title":"Histological correlates of carotid plaque surface morphology on lumen contrast imaging","volume":"110","author":"Lovett","year":"2004","journal-title":"Circulation"},{"key":"10.1016\/j.avsg.2026.10.007_bib16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1159\/000079259","article-title":"Reproducibility of histological assessment of carotid plaque: implications for studies of carotid imaging","volume":"18","author":"Lovett","year":"2004","journal-title":"Cerebrovasc Dis"},{"key":"10.1016\/j.avsg.2026.10.007_bib17","doi-asserted-by":"crossref","first-page":"3609","DOI":"10.1161\/STROKEAHA.119.026280","article-title":"Intensive Statin Therapy Compromises the Adiponectin-AdipoR Pathway in the Human Monocyte-Macrophage Lineage","volume":"50","author":"Gasbarrino","year":"2019","journal-title":"Stroke"},{"key":"10.1016\/j.avsg.2026.10.007_bib18","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1161\/STROKEAHA.116.015145","article-title":"Decreased Adiponectin-Mediated Signaling Through the AdipoR2 Pathway Is Associated With Carotid Plaque Instability","volume":"48","author":"Gasbarrino","year":"2017","journal-title":"Stroke"},{"key":"10.1016\/j.avsg.2026.10.007_bib19","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.ejvs.2019.07.015","article-title":"New Quantitative Digital Image Analysis Method of Histological Features of Carotid Atherosclerotic Plaques","volume":"58","author":"Zheng","year":"2019","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.avsg.2026.10.007_bib20","doi-asserted-by":"crossref","first-page":"286-91","DOI":"10.1016\/j.jvs.2009.01.065","article-title":"Proposed duplex velocity criteria for carotid restenosis following carotid endarterectomy with patch closure","volume":"50","author":"AbuRahma","year":"2009","journal-title":"J Vasc Surg"},{"key":"10.1016\/j.avsg.2026.10.007_bib21","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1226220","article-title":"Role of carotid duplex in the assessment of carotid artery restenosis after endarterectomy or stenting","volume":"14","author":"Szegedi","year":"2023","journal-title":"Front Neurol"},{"key":"10.1016\/j.avsg.2026.10.007_bib22","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23063346","article-title":"Pathophysiology of Atherosclerosis","volume":"23","author":"Jebari-Benslaiman","year":"2022","journal-title":"Int J Mol Sci"},{"key":"10.1016\/j.avsg.2026.10.007_bib23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1161\/01.STR.0000149622.12636.1f","article-title":"The risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease","volume":"36","author":"Alamowitch","year":"2005","journal-title":"Stroke"},{"key":"10.1016\/j.avsg.2026.10.007_bib24","first-page":"Cd001923","article-title":"Carotid endarterectomy for asymptomatic carotid stenosis","volume":"2005","author":"Chambers","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.avsg.2026.10.007_bib25","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1001\/jama.1995.03520420037035","article-title":"Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study","volume":"273","author":"Walker","year":"1995","journal-title":"JAMA"},{"key":"10.1016\/j.avsg.2026.10.007_bib26","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/S0140-6736(04)15785-1","article-title":"Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery","volume":"363","author":"Rothwell","year":"2004","journal-title":"Lancet"},{"key":"10.1016\/j.avsg.2026.10.007_bib27","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1161\/CIRCRESAHA.121.319915","article-title":"The Impact of Sex and Gender on Stroke","volume":"130","author":"Rexrode","year":"2022","journal-title":"Circ Res"},{"key":"10.1016\/j.avsg.2026.10.007_bib28","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1001\/jamacardio.2021.0683","article-title":"Sex-Related Disparities in Cardiovascular Health Care Among Patients With Premature Atherosclerotic Cardiovascular Disease","volume":"6","author":"Lee","year":"2021","journal-title":"JAMA Cardiol"},{"key":"10.1016\/j.avsg.2026.10.007_bib29","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.jvs.2019.10.093","article-title":"Incidence of and risk factors for postoperative urinary retention in men after carotid endarterectomy","volume":"72","author":"Boitano","year":"2020","journal-title":"J Vasc Surg"},{"key":"10.1016\/j.avsg.2026.10.007_bib30","doi-asserted-by":"crossref","first-page":"291","DOI":"10.3171\/jns.2000.92.2.0291","article-title":"Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics","volume":"92","author":"Papavasiliou","year":"2000","journal-title":"J Neurosurg"},{"key":"10.1016\/j.avsg.2026.10.007_bib31","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23095149","article-title":"Clinical Parameters and Epigenetic Biomarkers of Plaque Vulnerability in Patients with Carotid Stenosis","volume":"23","author":"Carballo-Perich","year":"2022","journal-title":"Int J Mol Sci"},{"key":"10.1016\/j.avsg.2026.10.007_bib32","article-title":"The journey to improving stroke risk stratification for patients with carotid artery stenosis: from medical management to revascularization","author":"Gianopoulos","year":"2025","journal-title":"Hellenic J Cardiol"},{"key":"10.1016\/j.avsg.2026.10.007_bib33","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/j.jcmg.2022.04.003","article-title":"Carotid Plaque Characteristics Predict Recurrent Ischemic Stroke and TIA: The PARISK (Plaque At RISK) Study","volume":"15","author":"van Dam-Nolen","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"key":"10.1016\/j.avsg.2026.10.007_bib34","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1016\/j.jacc.2021.01.038","article-title":"Atherosclerotic Carotid Plaque Composition and Incident Stroke and Coronary Events","volume":"77","author":"Bos","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.avsg.2026.10.007_bib35","doi-asserted-by":"crossref","first-page":"3288","DOI":"10.1161\/STROKEAHA.115.003390","article-title":"Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis","volume":"46","author":"Abbott","year":"2015","journal-title":"Stroke"},{"key":"10.1016\/j.avsg.2026.10.007_bib36","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1093\/ehjci\/jeae144","article-title":"Diagnostic accuracy of carotid plaque instability by noninvasive imaging: a systematic review and meta-analysis","volume":"25","author":"Pakizer","year":"2024","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"10.1016\/j.avsg.2026.10.007_bib37","doi-asserted-by":"crossref","first-page":"5850","DOI":"10.1038\/s41598-025-90319-2","article-title":"The value of contrast-enhanced ultrasound in assessing carotid plaque vulnerability and predicting stroke risk","volume":"15","author":"Cao","year":"2025","journal-title":"Sci Rep"},{"key":"10.1016\/j.avsg.2026.10.007_bib38","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.011302","article-title":"Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques","volume":"8","author":"Motoyama","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.avsg.2026.10.007_bib39","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2022.846690","article-title":"Sex and Age Differences in Patient-Reported Acute Stroke Symptoms","volume":"13","author":"Eddelien","year":"2022","journal-title":"Front Neurol"},{"key":"10.1016\/j.avsg.2026.10.007_bib40","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.jvs.2023.03.502","article-title":"Sex differences in outcome after carotid revascularization in symptomatic and asymptomatic carotid artery stenosis","volume":"78","author":"Kremer","year":"2023","journal-title":"J Vasc Surg"},{"key":"10.1016\/j.avsg.2026.10.007_bib41","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.avsg.2024.08.009","article-title":"The role of inflammation biomarkers in carotid artery stenosis procedures","volume":"110","author":"Scalise","year":"2025","journal-title":"Ann Vasc Surg"}],"container-title":["Annals of Vascular Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0890509626007302?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0890509626007302?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:31:58Z","timestamp":1792092718000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0890509626007302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":41,"alternative-id":["S0890509626007302"],"URL":"https:\/\/doi.org\/10.1016\/j.avsg.2026.10.007","relation":{},"ISSN":["0890-5096"],"issn-type":[{"value":"0890-5096","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Postoperative complications following carotid endarterectomy are differentially impacted by sex and plaque instability","name":"articletitle","label":"Article Title"},{"value":"Annals of Vascular Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.avsg.2026.10.007","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}