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The purpose of this study was to determine whether there was differential access to carotid endarterectomy (CEA) based on gender at our institution. In 1995, the year after ACAS results were published, 1774 carotid duplex studies were performed in our vascular laboratory in 765 men and 1009 women. The incidence of 50-99% carotid stenosis was 13% (n = 235) overall and did not differ between men (13.3%; 102/765) and women (13.2%; 133/1009). The frequency that patients subsequently underwent CEA was determined to assess whether men with significant carotid stenosis were more likely to undergo CEA than women. Attempts were made to contact patients with 50-99% stenosis directly. Data were available for 101 patients (41 men, 60 women) with 50-99% carotid stenosis diagnosed by carotid duplex. There was conflicting information regarding the possibility of gender bias in the selection of candidates for CEA: logistic regression analysis suggested that disease severity dictated surgical intervention, however, a significantly lower percentage of women with ICA/CCA peak systolic ratios > or =2.9 underwent CEA. This study cannot refute the possibility that gender bias existed in the selection of patients for CEA.