Sex differences in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction_West China Medical Journal

Authors：

LIU Quan ¹ , LIU Sijia ¹ , TANG Yong ¹ , GAN Qing ¹ , LIN Yapeng ² , HE Song ² ,  YANG Jie ^2,3,4

1. Emergency Department, Chengdu Second People’s Hospital, Chengdu, Sichuan 610000, P. R. China;
2. Department of Neurology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, P. R. China;
3. Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;
4. Department of Neurology, Nanjing First Hospital, Nanjing, Jiangsu 210000, P. R. China;

Corresponding author：

YANG Jie, Email: yangjie1126@163.com

Keywords：

Acute cerebral infarction; mechanical thrombectomy; functional outcome; gender

DOI：

10.7507/1002-0179.202211066

Video：

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Objective To explore the impact of gender difference in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction. Methods A prospective registration, observational, and retrospective analysis study was carried out. Patients with acute cerebral infarction who were admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College and the Department of Neurology of Nanjing First Hospital between June 2015 and June 2019 were collected. Patients were divided into two groups based on gender. The detailed demographic, laboratory examination, imaging examination and clinical data were collected. Then, the data were analyzed using univariate and multivariate logistic regression analyses. Results A total of 298 patients were included. Among them, there were 185 males and 113 females. The differences in age, smoking, atrial fibrillation, using antiplatelet drugs before stroke, TOAST classification, and involved cerebrovascular sites between the two groups were statistically significant (P<0.05), and there was no statistically significant difference in other baseline data between the two groups (P>0.05). The results of univariate logistic regression analysis showed that the rate of 90-day favourable outcome of female patients was lower than that of male patients [odds ratio (OR)=0.462, 95% confidence interval (CI) (0.275, 0.775), P=0.030]. The results of multivariate logistic regression analysis showed that, after adjusting for confounding factors, there was no independent correlation between gender and the 90-day favourable outcome of patients with acute cerebral infarction who underwent mechanical thrombectomy [OR=1.511, 95% CI (0.745, 3.066), P=0.253]. Conclusion The gender has no significant effect on the 90-day favourable outcome of acute cerebral infarction patients treated with mechanical thrombectomy.

Citation： LIU Quan, LIU Sijia, TANG Yong, GAN Qing, LIN Yapeng, HE Song, YANG Jie. Sex differences in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction. West China Medical Journal, 2023, 38(5): 698-703. doi: 10.7507/1002-0179.202211066 Copy

1.	Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 2015, 372(1): 11-20.
2.	Campbell BC, Mitchell PJ, EXTEND-IA Investigators. Endovascular therapy for ischemic stroke. N Engl J Med, 2015, 372(24): 2365-2366.
3.	Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015, 372(11): 1019-1030.
4.	Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med, 2015, 372(24): 2296-2306.
5.	Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med, 2015, 372(24): 2285-2295.
6.	Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2015, 46(10): 3020-3035.
7.	Lagebrant C, Ramgren B, Hassani Espili A, et al. Sex differences in collateral circulation and outcome after mechanical thrombectomy in acute ischemic stroke. Front Neurol, 2022, 13: 878759.
8.	Niewada M, Kobayashi A, Sandercock PA, et al. Inflfluence of gender on baseline features and clinical outcomes among 17, 370 patients with confifirmed ischaemic stroke in the international stroke trial. Neuroepidemiology, 2005, 24(3): 123-128.
9.	Lisabeth LD, Reeves MJ, Baek J, et al. Factors inflfluencing sex differences in poststroke functional outcome. Stroke, 2015, 46(3): 860-863.
10.	Persky RW, Turtzo LC, McCullough LD. Stroke in women: disparities and outcomes. Curr Cardiol Rep, 2010, 12(1): 6-13.
11.	Denti L, Artoni A, Scoditti U, et al. Impact of gender-age interaction on the outcome of ischemic stroke in an Italian cohort of patients treated according to a standardized clinical pathway. Eur J Intern Med, 2013, 24(8): 807-812.
12.	Fukuda M, Kanda T, Kamide N, et al. Gender differences in long-term functional outcome after first-ever ischemic stroke. Intern Med, 2009, 48(12): 967-973.
13.	Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet, 2016, 387(10029): 1723-1731.
14.	Madsen TE, DeCroce-Movson E, Hemendinger M, et al. Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg, 2019, 11(3): 221-225.
15.	Maeda K, Toyoda K, Minematsu K, et al. Effects of sex difference on clinical features of acute ischemic stroke in Japan. J Stroke Cerebrovasc Dis, 2013, 22(7): 1070-1075.
16.	de Ridder IR, Fransen PS, Beumer D, et al. Is intra-arterial treatment for acute ischemic stroke less effective in women than in men?. Interv Neurol, 2016, 5(3/4): 174-178.
17.	Chalos V, de Ridder IR, Lingsma HF, et al. Does sex modify the effect of endovascular treatment for ischemic stroke?. Stroke, 2019, 50(9): 2413-2419.
18.	Casetta I, Fainardi E, Pracucci G, et al. Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study. Eur Stroke J, 2022, 7(2): 151-157.
19.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 2018, 51(9): 666-682.
20.	Bushnell C, Howard VJ, Lisabeth L, et al. Sex differences in the evaluation and treatment of acute ischaemic stroke. Lancet Neurol, 2018, 17(7): 641-650.
21.	Uchida K, Yoshimura S, Sakai N, et al. Sex diferences in management and outcomes of acute ischemic stroke with large vessel occlusion. Stroke, 2019, 50(7): 1915-1918.
22.	Sheth SA, Lee S, Warach SJ, et al. Sex differences in outcome after endovascular stroke therapy for acute ischemic stroke. Stroke, 2019, 50(9): 2420-2427.
23.	Roy-O’Reilly M, McCullough LD. Age and sex are critical factors in ischemic stroke pathology. Endocrinology, 2018, 159(8): 3120-3131.
24.	Pérez-Sánchez S, Barragán-Prieto A, Ortega-Quintanilla J, et al. Sex differences by hospital-level in performance and outcomes of endovascular treatment for acute ischemic stroke. J Stroke, 2020, 22(2): 258-261.
25.	Tan BYQ, Siow I, Lee KS, et al. Effect of sex on outcomes of mechanical thrombectomy in basilar artery occlusion: a multicentre cohort study. Cerebrovasc Dis, 2022, 51(5): 639-646.
26.	Deb-Chatterji M, Schlemm E, Flottmann F, et al. Sex differences in outcome after thrombectomy for acute ischemic stroke are explained by confounding factors. Clin Neuroradiol, 2021, 31(4): 1101-1109.
27.	高洁, 程哲, 姜尚前, 等. 性别对急性缺血性卒中机械取栓术后神经功能预后的影响. 中国脑血管病杂志, 2021, 18(1): 30-36.

1. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 2015, 372(1): 11-20.
2. Campbell BC, Mitchell PJ, EXTEND-IA Investigators. Endovascular therapy for ischemic stroke. N Engl J Med, 2015, 372(24): 2365-2366.
3. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015, 372(11): 1019-1030.
4. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med, 2015, 372(24): 2296-2306.
5. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med, 2015, 372(24): 2285-2295.
6. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2015, 46(10): 3020-3035.
7. Lagebrant C, Ramgren B, Hassani Espili A, et al. Sex differences in collateral circulation and outcome after mechanical thrombectomy in acute ischemic stroke. Front Neurol, 2022, 13: 878759.
8. Niewada M, Kobayashi A, Sandercock PA, et al. Inflfluence of gender on baseline features and clinical outcomes among 17, 370 patients with confifirmed ischaemic stroke in the international stroke trial. Neuroepidemiology, 2005, 24(3): 123-128.
9. Lisabeth LD, Reeves MJ, Baek J, et al. Factors inflfluencing sex differences in poststroke functional outcome. Stroke, 2015, 46(3): 860-863.
10. Persky RW, Turtzo LC, McCullough LD. Stroke in women: disparities and outcomes. Curr Cardiol Rep, 2010, 12(1): 6-13.
11. Denti L, Artoni A, Scoditti U, et al. Impact of gender-age interaction on the outcome of ischemic stroke in an Italian cohort of patients treated according to a standardized clinical pathway. Eur J Intern Med, 2013, 24(8): 807-812.
12. Fukuda M, Kanda T, Kamide N, et al. Gender differences in long-term functional outcome after first-ever ischemic stroke. Intern Med, 2009, 48(12): 967-973.
13. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet, 2016, 387(10029): 1723-1731.
14. Madsen TE, DeCroce-Movson E, Hemendinger M, et al. Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg, 2019, 11(3): 221-225.
15. Maeda K, Toyoda K, Minematsu K, et al. Effects of sex difference on clinical features of acute ischemic stroke in Japan. J Stroke Cerebrovasc Dis, 2013, 22(7): 1070-1075.
16. de Ridder IR, Fransen PS, Beumer D, et al. Is intra-arterial treatment for acute ischemic stroke less effective in women than in men?. Interv Neurol, 2016, 5(3/4): 174-178.
17. Chalos V, de Ridder IR, Lingsma HF, et al. Does sex modify the effect of endovascular treatment for ischemic stroke?. Stroke, 2019, 50(9): 2413-2419.
18. Casetta I, Fainardi E, Pracucci G, et al. Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study. Eur Stroke J, 2022, 7(2): 151-157.
19. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 2018, 51(9): 666-682.
20. Bushnell C, Howard VJ, Lisabeth L, et al. Sex differences in the evaluation and treatment of acute ischaemic stroke. Lancet Neurol, 2018, 17(7): 641-650.
21. Uchida K, Yoshimura S, Sakai N, et al. Sex diferences in management and outcomes of acute ischemic stroke with large vessel occlusion. Stroke, 2019, 50(7): 1915-1918.
22. Sheth SA, Lee S, Warach SJ, et al. Sex differences in outcome after endovascular stroke therapy for acute ischemic stroke. Stroke, 2019, 50(9): 2420-2427.
23. Roy-O’Reilly M, McCullough LD. Age and sex are critical factors in ischemic stroke pathology. Endocrinology, 2018, 159(8): 3120-3131.
24. Pérez-Sánchez S, Barragán-Prieto A, Ortega-Quintanilla J, et al. Sex differences by hospital-level in performance and outcomes of endovascular treatment for acute ischemic stroke. J Stroke, 2020, 22(2): 258-261.
25. Tan BYQ, Siow I, Lee KS, et al. Effect of sex on outcomes of mechanical thrombectomy in basilar artery occlusion: a multicentre cohort study. Cerebrovasc Dis, 2022, 51(5): 639-646.
26. Deb-Chatterji M, Schlemm E, Flottmann F, et al. Sex differences in outcome after thrombectomy for acute ischemic stroke are explained by confounding factors. Clin Neuroradiol, 2021, 31(4): 1101-1109.
27. 高洁, 程哲, 姜尚前, 等. 性别对急性缺血性卒中机械取栓术后神经功能预后的影响. 中国脑血管病杂志, 2021, 18(1): 30-36.

West China Medical Journal

Sex differences in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction

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