Abstract
PurposeThe aim of this study was to analyze sex differences in outcome after thrombectomy for acute ischemic stroke in clinical practice in a large prospective multicenter registry.MethodsData of consecutive stroke patients treated with thrombectomy (June 2015–April 2018) derived from an industry-independent registry (German Stroke Registry–Endovascular Treatment) were prospectively analyzed. Multivariable binary logistic regression analyses were applied to determine whether sex is a predictor of functional independence outcome (defined as a modified Rankin scale [mRS] 0–2) 90 days after stroke.ResultsIn total, 2316 patients were included in the analysis, 1170 (50.5%) were female and 1146 (49.5%) were male. Women were older (median age 78 vs. 72 years; p < 0.001) and more frequently had a prestroke functional impairment defined by mRS >1 (24.8% vs. 14.1%; p < 0.001). In unadjusted analyses, independent outcome at 90 days was less frequent in women (33.2%) than men (40.6%; p < 0.001). Likewise, mortality was higher in women than in men (30.7% vs. 26.4%; p = 0.024). In adjusted regression analyses, however, sex was not associated with outcome. Lower age, a lower baseline National Institutes of Health Stroke Scale score, a higher Alberta Stroke Program Early CT score, prestroke functional independence, successful reperfusion, and concomitant intravenous thrombolysis therapy predicted independent outcome.ConclusionWomen showed a worse functional outcome after thrombectomy for acute ischemic stroke in clinical practice; however, after adjustment for crucial confounders sex was not a predictor of outcome. The difference in outcome thus appears to result from differences in confounding factors such as age and prestroke functional status.
Highlights
Multiple randomized controlled trials (RCTs) have demonstrated the efficacy of endovascular treatment (EVT) among patients with acute ischemic stroke caused by large vessel occlusions
Several studies have reported worse outcome for females after acute ischemic stroke compared to males [1,2,3,4,5]; conflicting results were reported on sex differences in outcome after stroke thrombectomy
Post hoc analyses of RCTs on stroke thrombectomy within the HERMES collaboration suggested that sex does not influence functional outcome after EVT and demonstrated a similar proportion of both women and men, achieving functional independence 90 days after intervention [6]
Summary
Multiple randomized controlled trials (RCTs) have demonstrated the efficacy of endovascular treatment (EVT) among patients with acute ischemic stroke caused by large vessel occlusions. Several studies have reported worse outcome for females after acute ischemic stroke compared to males [1,2,3,4,5]; conflicting results were reported on sex differences in outcome after stroke thrombectomy. Post hoc analyses of RCTs on stroke thrombectomy within the HERMES collaboration suggested that sex does not influence functional outcome after EVT and demonstrated a similar proportion of both women and men, achieving functional independence 90 days after intervention [6]. Similar results were obtained in a pooled analysis of patients from different trial cohorts, which did not find a gender difference in outcome at 90 days, females were older and had higher rates of atrial fibrillation [7].
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