大血管闭塞性卒中血管内治疗结局的性别差异——来自德国卒中登记处血管内治疗的分析
Sex-Related Differences in Outcomes of Endovascular Treatment in Large Vessel Occlusion Stroke-Analyses From the German Stroke Registry-Endovascular Treatment.
作者信息
Single Constanze, Mengel Annerose, Laichinger Kornelia, Sartor-Pfeiffer Jennifer, Selo Nadja, Hennersdorf Florian, Bender Benjamin, Deb-Chatterji Milani, Thomalla Götz, Mbroh Joshua, Poli Sven, Ziemann Ulf, Ernemann Ulrike, Feil Katharina
机构信息
Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany.
Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany.
出版信息
Eur J Neurol. 2025 Mar;32(3):e70092. doi: 10.1111/ene.70092.
BACKGROUND
Sex-related differences in acute ischemic stroke may affect outcomes, yet evidence remains inconsistent. This large-scale study investigated sex-related differences in clinical presentation, peri-interventional parameters, and outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) using data from the German Stroke Registry-Endovascular Treatment (GSR-ET).
METHODS
We analyzed 11.896 EVT patients (52.2% female) from the GSR-ET (June 2015-December 2021) comparing clinical characteristics, treatment details, and outcomes by sex. Two propensity score matchings (PSM) were applied: (1) logistic regression model with a caliper width of 0.1 on age, pre-stroke modified Rankin Scale (pmRS), and National Institutes of Health Stroke Scale at admission, and (2) 1:1 nearest neighbor matching with a caliper of 0.01. Primary outcomes were good (mRS 0-2) and excellent (mRS 0-1) outcomes at discharge and 90-day follow-up.
RESULTS
Women were older (76.3 ± 12.7 vs. 70.2 ± 12.9 years, p < 0.001) and had higher pre-stroke disability (median pmRS 0 (0, 2) vs. 0 (0, 1), p < 0.001). Cardioembolic strokes were more frequent in women, even after PSM. Despite this, women had better odds of achieving good outcomes at discharge (adjusted OR 1.20, 95% CI 1.04-1.38, p = 0.013), but not at follow-up (OR 0.91, 95% CI 0.78-1.05, p = 0.193). Both PSM analyses confirmed these findings.
CONCLUSIONS
While women demonstrated better short-term functional outcomes after EVT, these benefits diminished in follow-up. The persistence of cardioembolic stroke in women suggests potential sex-specific mechanisms. Understanding and addressing sex-related differences in stroke is essential to optimize acute stroke care and improve outcomes. Future studies should explore biological and socio-economic factors influencing sex-related differences.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT03356392.
背景
急性缺血性卒中的性别差异可能会影响预后，但证据仍不一致。这项大规模研究利用德国卒中登记处血管内治疗（GSR-ET）的数据，调查了大血管闭塞（LVO）患者血管内血栓切除术（EVT）后在临床表现、围手术期参数和预后方面的性别差异。
方法
我们分析了GSR-ET（2015年6月至2021年12月）中的11896例EVT患者（52.2%为女性），按性别比较临床特征、治疗细节和预后。应用了两种倾向评分匹配（PSM）方法：（1）逻辑回归模型，年龄、卒中前改良Rankin量表（pmRS）和入院时美国国立卫生研究院卒中量表的卡尺宽度为0.1；（2）1:1最近邻匹配，卡尺为0.01。主要结局是出院时和90天随访时良好（mRS 0-2）和优异（mRS 0-1）的预后。
结果
女性年龄更大（76.3±12.7岁 vs. 70.2±12.9岁，p<0.001），卒中前残疾程度更高（pmRS中位数0（0，2） vs. 0（0，1），p<0.001）。即使在PSM后，心源性栓塞性卒中在女性中也更常见。尽管如此，女性出院时获得良好预后的几率更高（调整后的OR 1.20，95%CI 1.04-1.38，p=0.013），但随访时并非如此（OR 0.91，95%CI 0.78-1.05，p=0.193）。两种PSM分析均证实了这些发现。
结论
虽然女性在EVT后显示出更好的短期功能预后，但这些益处在随访中减弱。女性中心源性栓塞性卒中的持续存在提示了潜在的性别特异性机制。了解和解决卒中中的性别差异对于优化急性卒中治疗和改善预后至关重要。未来的研究应探索影响性别差异的生物学和社会经济因素。
试验注册
ClinicalTrials.gov标识符：NCT03356392。
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