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Sex-specific differences in presentations and determinants of outcomes after endovascular thrombectomy for large vessel occlusion stroke

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Abstract

Introduction

Sex-specific differences in ischemic stroke outcomes are prevalent. We sought to investigate sex differences in the determinants of reperfusion and functional outcomes after endovascular thrombectomy (EVT) for emergent large vessel occlusion ischemic stroke (ELVO).

Methods

Patients presenting to a single referral center with an anterior circulation ELVO that underwent EVT from 2011 to 2019 were included in this retrospective analysis. Sex differences in history, presentation, adequate reperfusion (TICI 2b-3), and 90-day good outcome [delta modified Rankin Scale (mRS) ≤ 2 from pre-stroke] were examined. Multivariable logistic regression analyses were performed to assess sex-specific associations with outcomes.

Results

Three hundred and eighty-one consecutive ELVO patients were identified. Women (N = 193) were older (75 vs 64 years, p < 0.0001), had more pre-stroke disability (17% vs 9%, p = 0.032), more atrial fibrillation (41% vs 30%, p = 0.033), but less carotid atherosclerosis (8% vs 16%, p = 0.027). Rates of TICI 2b-3 and good outcome were similar between sexes. Carotid atherosclerosis (OR 0.315, 95% CI 0.130, 0.762) and dissection (OR 0.124, 95% CI 0.027, 0.569) independently decreased the odds of TICI 2b-3 among men but not women. Older age, more severe stroke, and not achieving TICI 2b-3 independently decreased the odds of good outcome among both sexes, while prior stroke (OR 0.258, 95% CI 0.083, 0.797) and hemorrhagic transformation (OR 0.111, 0.021, 0.592) were determinants exclusive to men.

Conclusion

In a real-world analysis of ELVO stroke patients treated with EVT, we found that despite advanced age and more pre-stroke disability, women have comparable reperfusion rates and functional outcomes compared to men. Sex-specific determinants of reperfusion and functional outcome were identified that require further study.

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Data availability

The data that support the findings of this study will be made available from the corresponding author upon reasonable request and pending approval of local institutional review board.

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Acknowledgements

We would like to thank Joyce A. McIntyre for her work maintaining the prospective Massachusetts General Hospital stroke database. This work was supported by the National Institute of Neurological Disorders and Stroke [Grant Number R25 NS065743].

Funding

This work was supported by the National Institute of Neurological Disorders and Stroke [Grant Number R25 NS065743].

Author information

Authors and Affiliations

Authors

Contributions

RWR, ACT, NSR, and MRE researched literature and conceived the study. RWR, TLM, NSR, and MRE were involved in protocol development, gaining ethical approval and data analysis. RWR and ACT wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Robert W. Regenhardt.

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Conflict of interest

None relevant.

Ethics approval

The ethics committee of Massachusetts General Hospital approved this study.

Informed consent

Waived based on minimal patient risk and practical inability to perform the study without the waiver.

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Regenhardt, R.W., Turner, A.C., Hirsch, J.A. et al. Sex-specific differences in presentations and determinants of outcomes after endovascular thrombectomy for large vessel occlusion stroke. J Neurol 269, 307–315 (2022). https://doi.org/10.1007/s00415-021-10628-0

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  • DOI: https://doi.org/10.1007/s00415-021-10628-0

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