KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven, Belgium; VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; University Hospitals Leuven, Department of Neurology, Herestraat 49, Leuven B-3000, Belgium.
Stanford Stroke Center, Stanford, United States.
J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105468. doi: 10.1016/j.jstrokecerebrovasdis.2020.105468. Epub 2020 Nov 21.
It is unclear if sex differences explain some of the variability in the outcomes of stroke patients who undergo endovascular treatment (EVT). In this study we assess the effect of sex on radiological and functional outcomes in EVT-treated acute stroke patients and determine if differences in baseline perfusion status between men and women might account for differences in outcomes.
We included patients from the CRISP (Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke) study, a prospective cohort study of acute stroke patients who underwent EVT up to 18 hours after last seen well. We designed ordinal regression and univariable and multivariable regression models to examine the association between sex and infarct growth, final infarct volume and 90-day mRS score.
We included 198 patients. At baseline, women had smaller perfusion lesions, more often had a target mismatch perfusion profile, and had better collateral perfusion. Women experienced less ischemic core growth (median 15 mL vs. 29 mL, p < 0.01) and had smaller final infarct volumes (median 26 mL vs. 50 mL, p < 0.01). Female sex was associated with a favorable shift on the modified Rankin Scale (adjusted cOR 1.79 [1.04 - 3.08; p = 0.04]) and lower odds of severe disability or death (adjusted OR 0.29 [0.10 - 0.81]; p = 0.02).
The results suggest that women have better collaterals and, therefore, more often exhibit a favorable imaging profile on baseline imaging, experience less lesion growth, and have better clinical outcomes following endovascular therapy.
接受血管内治疗（EVT）的中风患者结局的变异性是否部分由性别差异导致尚不清楚。本研究评估了性别对 EVT 治疗的急性中风患者影像学和功能结局的影响，并确定男女之间基线灌注状态的差异是否可能导致结局的差异。
我们纳入了来自 CRISP（计算机断层灌注预测缺血性中风再灌注反应）研究的患者，该研究为急性中风患者的前瞻性队列研究，在最后一次看到正常后 18 小时内进行了 EVT。我们设计了有序回归和单变量及多变量回归模型，以检验性别与梗死体积增长、最终梗死体积和 90 天 mRS 评分之间的关联。
我们纳入了 198 名患者。基线时，女性的灌注病变较小，更常出现靶匹配灌注模式，且侧支循环灌注更好。女性的缺血核心体积增长较少（中位数 15 毫升 vs. 29 毫升，p < 0.01），最终梗死体积较小（中位数 26 毫升 vs. 50 毫升，p < 0.01）。女性性别与改良 Rankin 量表的有利转变相关（校正 cOR 1.79 [1.04 - 3.08；p = 0.04]），且严重残疾或死亡的可能性降低（校正 OR 0.29 [0.10 - 0.81]；p = 0.02）。
结果表明，女性的侧支循环更好，因此在基线影像学上更常表现出有利的影像特征，梗死体积增长较少，并且在接受血管内治疗后临床结局更好。
