Sexual dimorphism in peripheral blood cell characteristics relate to success of endovascular thrombectomy in acute ischemic stroke

Abstract

Abstract Introduction The success of endovascular thrombectomy (EVT) in acute ischemic stroke is related to stroke etiology and clot composition. The latter two may differ between women and men. An improved understanding of sex differences in EVT success may contribute to more personalized treatment. We therefore tested the hypothesis that blood cell characteristics (BCCs) related to EVT success in acute ischemic stroke differ by sex. Methods We analyzed electronic health record (EHR) data of AIS patients undergoing EVT at a single intervention center. Of 311 patients, 71 pretreatment erythrocyte-, leukocyte-, and thrombocyte-related BCCs from the Sapphire hematology analyzer were extracted. BCCs were sex-stratified, clustered, and analyzed based on the first principal component of the clusters. To identify BCC clusters related to successful EVT (TICI 3), Partial Least Squares Discriminant Analysis (sPLS-DA) was performed, including cross-validation and stability selection to identify stable BCCs relative to EVT success in women and men. We also related the identified BCCs to stroke etiology (cardioembolism (CE), large-artery atherosclerosis (LAA), undetermined), and controlled for known cardiovascular risk factors. Results Successful EVT was achieved in 69 women (51%) and 87 men (49%). Women and men differed on 21 out of 71 BCCs (pFDR-corrected < 0.05). Analyzing sex-stratified data led to lower error rates for the female model for EVT success compared to the pooled (t(192.4) = 5.9, p < 0.001), and male model (t(182.6) = -15.6, p < 0.001). In women, a higher number of reticulocytes was associated with successful EVT and CE, whereas a higher mean corpuscular hemoglobin concentration was associated with unsuccessful EVT and LAA. In men, a higher coefficient of variance of lymphocyte complexity of the intracellular structure was associated unsuccessful EVT and LAA. Conclusions BCCs associated with EVT success differed by sex and were related to stroke subtype. This improved understanding may contribute to more personalized treatment of acute ischemic stroke.Model performance after sex-stratifyingSex-specific BCCs relate to EVT success