Effect of Sex on Clinical Outcome and Imaging after Endovascular Treatment of Large-Vessel Ischemic Stroke

 So you have work to do to get both sexes the same results and that is 100% recovery. Hopefully your mentors and senior researchers already have plans on how to get there. If they don't they need to be fired.

Effect of Sex on Clinical Outcome and Imaging after Endovascular Treatment of Large-Vessel Ischemic Stroke

• Jelle Demeestere, MD
• Sören Christensen, PhD
• Michael Mlynash, MD, MS
• 
  
• Gregory W. Albers, MD, PhD
• Robin Lemmens, MD, PhD
• Maarten G. Lansberg, MD, PhD
• Show all authors

Published:November 21, 2020DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105468

Abstract

Background and Purpose

It is unclear if sex differences explain some of the variability in the outcomes of stroke patients who undergo endovascular treatment (EVT). In this study we assess the effect of sex on radiological and functional outcomes in EVT-treated acute stroke patients and determine if differences in baseline perfusion status between men and women might account for differences in outcomes.

Methods

We included patients from the CRISP (Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke) study, a prospective cohort study of acute stroke patients who underwent EVT up to 18 hours after last seen well. We designed ordinal regression and univariable and multivariable regression models to examine the association between sex and infarct growth, final infarct volume and 90-day mRS score.

Results

We included 198 patients. At baseline, women had smaller perfusion lesions, more often had a target mismatch perfusion profile, and had better collateral perfusion. Women experienced less ischemic core growth (median 15 mL vs. 29 mL, p < 0.01) and had smaller final infarct volumes (median 26 mL vs. 50 mL, p < 0.01). Female sex was associated with a favorable shift on the modified Rankin Scale (adjusted cOR 1.79 [1.04 - 3.08; p = 0.04]) and lower odds of severe disability or death (adjusted OR 0.29 [0.10 – 0.81]; p = 0.02).

Conclusions

The results suggest that women have better collaterals and, therefore, more often exhibit a favorable imaging profile on baseline imaging, experience less lesion growth, and have better clinical outcomes following endovascular therapy.

Key Words

• Stroke
• Thrombectomy
• Magnetic resonance imaging
• Perfusion imaging
• Women
• Sex

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