Failed recanalization mediates the association of women with poor outcomes after thrombectomy: a single-center experience

Abstract

Background: Whether thrombectomy benefits differ according to sex remains debatable. We aimed to investigate whether there was a difference in stroke outcomes between men and women treated with thrombectomy.Methods: We studied 173 patients with anterior circulation strokes. Failed recanalization was defined as thrombolysis in cerebral infarction grade 0-2a. Scores >2 on the modified Rankin Scale at 3 months were regarded as poor outcomes. To prove that failed recanalization mediated the association between sex differences and functional outcome, the four steps of the reasoning process adapted from Baron and Kenny’s causal-steps approach were tested. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Results: This study included 76 women and 97 men. Women were older and presented with atrial fibrillation more frequently than men. Female sex was independently associated with failed recanalization (aOR, 2.729; 95% CI, 1.334–5.582), which was an independent predictor of poor outcomes (aOR, 4.630; 95% CI, 1.882–11.389). Women were associated with poor outcomes in the analysis adjusted for confounders, except for failed recanalization (aOR, 2.285; 95% CI, 1.064–4.906). However, the association became insignificant in the additional analysis adjusted for failed recanalization (aOR, 1.670; 95% CI, 0.738–3.784). The indirect effect between female sex and poor outcomes via failed recanalization was statistically significant (aOR, 1.038; 95% CI, 1.010–1.127). Conclusion: Our study showed that failed recanalization mediated the association between women and poor outcomes after thrombectomy. Nonetheless, this might be explained by chance given our limited study population.