Abstract 2974: Sex Differences in Correlation of Cerebral Infarction Volume with Functional Outcome

Abstract

Background: Studies have suggested worse functional outcomes in women after acute ischemic stroke. Following intravenous thrombolysis, they have higher recanalization rates; however, sex-based differential outcomes are poorly studied in large vessel occlusion +− intra-arterial therapy. We sought to ascertain the correlation between infarcted brain tissue volume and functional outcome in women as compared to men who were potential neurointerventional therapy candidates. Methods: We retrospectively queried our prospectively maintained acute potential neurointerventional candidate and neuroimaging patient database (n=283) and correlated final DWI cerebral infarction volume with functional outcomes as measured by the modified Rankin Scale [MRS] at hospital discharge and 30 days. Results: Median age was 69 [56,79] and 185 patients received intra-arterial therapy including 103 women (55.7%). There were no differences in age or admission NIHSS score, initial or final DWI infarction volumes, premorbid MRS, site of large vessel occlusion, pre-intervention collateral grade, TIMI or TICI grade, or recanalization rate between the sexes. Spearman correlation coefficients (r 2 ) between final DWI infarction volume and functional outcomes for neurointerventionally treated men as compared to women were 0.45 [men, p=.0009] versus (vs) 0.12 [women, p=.41] for discharge MRS; 0.78 [men, p<.0001] vs -0.27 [women, p=.17] for 30 day MRS, and 0.78 [men, p<.001] vs -0.26 (women, p=.26]. For all women vs men irrespective of treatment, the r 2 values were 0.53 [men, p<.0001] vs 0.35 [women, p=.009] for discharge MRS; 0.60 [men, p<.0001] vs 0.05 [women, p=.73] for 30 day MRS; and 0.68 [men, p<.001] vs -0.078 [women, p=.66]. These differences were confirmed by an ordinal logistic regression analysis. Conclusions: Despite comparable baseline functional status, treatment rate, occlusion site, initial and final infarction volumes, and recanalization rates, final infarction volume correlates strongly with functional outcome in men but not in women. This data suggests fundamental differences in neurophysiological or social factors between men and women in response to acute large vessel stroke, the nature of which deserves to be more fully investigated.