Neurology, Massachusetts General Hospital, 55 Fruit St, WAC-7-721, Boston, MA, USA.
Neurosurgery, Massachusetts General Hospital, 55 Fruit St, WAC-7-721, Boston, MA, USA.
J Neurol. 2022 Jan;269(1):307-315. doi: 10.1007/s00415-021-10628-0. Epub 2021 May 29.
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).
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.
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.
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.
在缺血性脑卒中的结果中存在明显的性别差异。我们旨在探讨血管内血栓切除术（EVT）治疗急性大血管闭塞性缺血性脑卒中（ELVO）后再灌注和功能结果的决定因素中的性别差异。
本回顾性分析纳入了 2011 年至 2019 年期间在单一转诊中心就诊的前循环 ELVO 患者，这些患者接受了 EVT。检查了病史、表现、充分再灌注（TICI 2b-3）和 90 天良好结局（与基线相比改良 Rankin 量表评分变化值≤2 分）的性别差异。进行了多变量逻辑回归分析以评估与结局相关的性别特异性关联。
共确定了 381 例连续的 ELVO 患者。女性（N=193）年龄更大（75 岁比 64 岁，p＜0.0001），术前残疾更多（17%比 9%，p=0.032），心房颤动更多（41%比 30%，p=0.033），但颈动脉粥样硬化更少（8%比 16%，p=0.027）。男女之间的 TICI 2b-3 再灌注率和良好结局率相似。颈动脉粥样硬化（OR 0.315，95%CI 0.130，0.762）和夹层（OR 0.124，95%CI 0.027，0.569）独立降低了男性的 TICI 2b-3 可能性，但对女性没有影响。年龄较大、更严重的脑卒中以及未达到 TICI 2b-3 独立降低了两性的良好结局可能性，而既往脑卒中（OR 0.258，95%CI 0.083，0.797）和出血性转化（OR 0.111，95%CI 0.021，0.592）是仅存在于男性的决定因素。
在接受 EVT 治疗的 ELVO 脑卒中患者的真实世界分析中，我们发现尽管女性年龄较大且术前残疾更多，但她们的再灌注率和功能结局与男性相当。确定了再灌注和功能结果的性别特异性决定因素，需要进一步研究。
