The combination of heart disease and stroke is currently the leading cause of death in the United States, claiming more lives than all forms of cancer and chronic lower respiratory disease combined [1]. Stroke is also the leading cause of long-term disability in the United States of America and caused over 165,000 deaths in 2022 alone; about 20% of strokes are related to internal carotid artery (ICA) stenosis. Various modalities for carotid intervention including carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS) and trans-carotid artery stenting (TCAR) have demonstrated efficacy in decreasing the risk of stroke for both symptomatic and asymptomatic patients [[2], [3], [4], [5]].

Gender and race-based disparities have been identified in various areas of vascular disease over the past several decades. In some disease processes, like aortic aneurysms or peripheral arterial disease, these differences have led to changes in real-world practice patterns, management strategies or thresholds for intervention based on gender or ethnicity [6]. Based on epidemiologic studies, stroke incidence and prevalence is higher in men, but strokes that occur in women tend to be more severe as evidenced by increased 1-month case fatality compared to men (24.7% vs. 19.7%) [7]. Women and minorities have also been historically under-represented in major trials, leading to decreased understanding of the natural history of vascular disease or procedural outcomes for these populations. In fact, it was not until 1994 that the National Institute of Health mandated inclusion of women and minorities research studies.

For carotid artery stenosis specifically, there has been much debate regarding the impact of gender or ethnicity on outcomes after carotid revascularization. In this article, we review the available literature to assess differences in diagnosis, management and outcomes of carotid artery stenosis based on race or gender.