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Sex differences in outcomes of endovascular therapy for acute vertebrobasilar occlusion: data from ANGEL-ACT Registry

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Abstract

Background

Understanding sex disparities in stroke can identify gaps in clinical care. The objective of this study was to investigate whether sex differences could influence clinical outcomes of patients with acute vertebrobasilar artery occlusion (VBAO) who underwent endovascular therapy (EVT).

Methods

Patients were selected from the ANGEL-ACT Registry. The primary outcome was favorable functional outcome (90-day modified Rankin Scale [mRS] 0–3). Secondary outcomes included 90-day mRS distribution, excellent outcome (mRS 0–1), functional independence (mRS 0–2), early neurological improvement, recanalization, intracranial hemorrhage, and mortality within 90 days. The above outcomes were compared by two adjustment models, including (1) multivariable logistics analysis adjusting for all baseline and procedural variables with a P < 0.05; (2) adjusting for the propensity score.

Results

There were 347 acute VBAO patients treated with EVT included, of whom 72 (20.7%) were women and 275 (79.3%) were men. Women were older (72[63–76] vs. 62[53–69], P < 0.001) and had a higher rate of atrial fibrillation (31.9% vs. 8.7%, P < 0.001), lower rates of underlying intracranial atherosclerotic disease (30.6% vs. 51.3%, P = 0.007), and tandem occlusion (8.3% vs. 21.8%, P = 0.009) than men. The rate of favorable outcome (mRS 0–3) was similar between women and men (41.7% vs. 51.3%, adjusted odds ratio 1.56, 95%CI: 0.83–2.95, P = 0.171). There were no sex differences in other clinical outcomes (all P > 0.05).

Conclusions

In the ANGEL-ACT registry, the percentage of men with acute VBAO undergoing EVT was approximately fourfold higher than that of women with acute VBAO undergoing EVT. Sex differences did not modify the outcomes of acute VBAO after EVT.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all clinicians, statisticians, and imaging and laboratory technologists who were involved in the ANGEL-ACT registry.

Funding

The ANGEL-ACT registry was funded by the National Key Research and Development Program of China, Grant number 2016YFC1301500.

Author information

Author notes

  1. Xiaochuan Huo and Dapeng Sun contributed equally to this work.

Authors and Affiliations

  1. Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, NO. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China

    Xiaochuan Huo

  2. Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Dapeng Sun,  Raynald, Baixue Jia, Xu Tong, Ning Ma, Feng Gao, Dapeng Mo & Zhongrong Miao

  3. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Anxin Wang

  4. Department of Neurology, Radiology, Boston Medical Center, Boston, MA, USA

    Thanh N. Nguyen

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Consortia

the ANGEL-ACT study group

Contributions

ZM, XH, and DS were involved in the study conception. Statistical analysis was done by AW. The article was drafted by DS. All the authors reviewed and approved the final article.

Corresponding authors

Correspondence to Xiaochuan Huo, Thanh N. Nguyen or Zhongrong Miao.

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Conflicts of interest

Dr. Nguyen reports research support from Medtronic and the Society of Vascular and Interventional Neurology (unrelated). Other authors have no conflict of interest.

Ethics approval

The study was approved by the ethics committees of Beijing Tiantan Hospital and all participating centers. The ID of the approval is KY2017-048-01. Subjects or their legally authorized representatives provided written informed consent prior to commencing the study.

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Huo, X., Sun, D., Raynald et al. Sex differences in outcomes of endovascular therapy for acute vertebrobasilar occlusion: data from ANGEL-ACT Registry. J Neurol 271, 1376–1384 (2024). https://doi.org/10.1007/s00415-023-12078-2

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