From the Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston (S.A.S., S.L., L.D.M.).
Department of Neurology, Dell School of Medicine, University of Texas at Austin (S.J.W.).
Stroke. 2019 Sep;50(9):2420-2427. doi: 10.1161/STROKEAHA.118.023867. Epub 2019 Aug 15.
Background and Purpose- We determined the effect of sex on outcome after endovascular stroke thrombectomy in acute ischemic stroke, including lifelong disability outcomes. Methods- We analyzed patients treated with the Solitaire stent retriever in the combined SWIFT (Solitaire FR With the Intention for Thrombectomy), STAR (Solitaire FR Thrombectomy for Acute Revascularization), and SWIFT PRIME (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment) cohorts. Ordinal and logistic regression were used to examine known factors influencing outcome after endovascular stroke thrombectomy and study the effect of sex on the association between these factors and outcomes, including age and time to reperfusion. Years of optimal life after thrombectomy were defined as disability-adjusted life years and calculated by projecting disability through adjusted poststroke life expectancy by sex. Results- Among 389 patients treated with endovascular stroke thrombectomy, 55% were females, and median National Institutes of Health Stroke Scale was 17 (interquartile range, 8-28). There were no differences between females versus males in presenting deficit severity (National Institutes of Health Stroke Scale score, 17 versus 17, P=0.21), occlusion location (69% versus 64% M1, P=0.62), presenting infarct extent (Alberta Stroke Program Early CT Score 8 versus 8, P=0.24), rate of substantial reperfusion (Thrombolysis in Cerebral Infarction 2b/3, 87% versus 83%, P=0.37), onset to reperfusion time (294 versus 302 minutes, P=0.46). Despite older ages (69 versus 64, P<0.001) and higher rate of atrial fibrillation (45% versus 30%, P=0.002) for females compared with males, adjusted rates of functional independence at 90 days were similar (odds ratio, 1.0; 95% CI, 0.6-1.6). After adjusting for age at presentation and stroke severity, females had more years of optimal life (disability-adjusted life year) after endovascular stroke thrombectomy, 10.6 versus 8.5 years (P<0.001). Conclusions- Despite greater age and higher rate of atrial fibrillation, females experienced comparable functional outcomes and greater years of optimal life after intervention compared with males.
我们旨在研究性别对急性缺血性脑卒中血管内取栓治疗后结局的影响，包括终身残疾结局。方法：我们分析了接受 Solitaire 支架取栓器治疗的 SWIFT（Solitaire FR 取栓术伴取栓意图）、STAR（Solitaire FR 取栓术用于急性血管再通）和 SWIFT PRIME（Solitaire FR 取栓术伴取栓意图作为主要血管内治疗）队列中的患者。采用有序和逻辑回归来检验已知影响血管内取栓治疗后结局的因素，并研究性别对这些因素与结局之间关联的影响，包括年龄和再灌注时间。取栓术后的最佳预期寿命是通过调整后的性别预测的残疾后预期寿命来定义的，用失能调整生命年来表示。结果：在 389 例接受血管内取栓治疗的患者中，55%为女性，中位 NIHSS 评分为 17 分（四分位距，8-28 分）。女性与男性在发病时的严重程度（NIHSS 评分，17 分比 17 分，P=0.21）、闭塞部位（69%比 64%为 M1，P=0.62）、发病时梗死范围（Alberta 卒中项目早期 CT 评分 8 分比 8 分，P=0.24）、充分再灌注率（脑梗死溶栓分级 2b/3 级，87%比 83%，P=0.37）、起病至再灌注时间（294 分钟比 302 分钟，P=0.46）方面均无差异。尽管女性的年龄较大（69 岁比 64 岁，P<0.001），心房颤动发生率较高（45%比 30%，P=0.002），但调整后的 90 天功能独立性率相似（比值比，1.0；95%CI，0.6-1.6）。在校正发病年龄和卒中严重程度后，女性接受血管内取栓治疗后的最佳预期寿命（失能调整生命年）更长，为 10.6 年比 8.5 年（P<0.001）。结论：尽管女性年龄较大，心房颤动发生率较高，但与男性相比，女性的功能结局相似，且术后干预后的最佳预期寿命更长。
