Sex Differences in Outcomes of Late-Window Endovascular Stroke Therapy

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Mohamad Abdalkader - , Boston Medical Center (BMC) (Author)
  • Shen Ning - , Boston Medical Center (BMC) (Author)
  • Muhammad M Qureshi - , Boston Medical Center (BMC) (Author)
  • Diogo C Haussen - , Grady Memorial Hospital (D.C.H (Author)
  • Daniel Strbian - , Helsinki University Hospital (HUS) (Author)
  • Simon Nagel - , Department of Neurology (Author)
  • Jelle Demeestere - , Laboratory for Neurobiology (Author)
  • Volker Puetz - , Dresden Neurovascular Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden (Author)
  • Mahmoud H Mohammaden - , Grady Memorial Hospital (D.C.H (Author)
  • Marta Olive Gadea - , Vall d'Hebron University Hospital (Author)
  • Simon Winzer - , Dresden Neurovascular Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden (Author)
  • Hiroshi Yamagami - , National Hospital Organization Osaka Medical Center (Author)
  • Kanta Tanaka - , National Cerebral and Cardiovascular Center (Author)
  • João Pedro Marto - , Boston Medical Center (BMC) (Author)
  • Liisa Tomppo - , Helsinki University Hospital (HUS) (Author)
  • Hilde Henon - , Université de Lille (Author)
  • Sunil A Sheth - , Neurology McGovern Medical School at UTHealth TX (Author)
  • Santiago Ortega-Gutierrez - , University of Iowa (S.O.-G (Author)
  • Nicolas Martinez-Majander - , Helsinki University Hospital (HUS) (Author)
  • Francois Caparros - , Université de Lille (Author)
  • Robin Lemmens - , Laboratory for Neurobiology (Author)
  • Anne Dusart - , Department of Neurology (Author)
  • Flavio Bellante - , Department of Neurology (Author)
  • Syed F Zaidi - , University of Toledo (Author)
  • James E Siegler - , University of Chicago (J.E.S.) (Author)
  • Stefania Nannoni - , University of Cambridge (Author)
  • Johannes Kaesmacher - , Inselspital University Hospital Bern (Author)
  • Tomas Dobrocky - , Inselspital University Hospital Bern (Author)
  • Mudassir Farooqui - , University of Iowa (S.O.-G (Author)
  • Sergio Salazar-Marioni - , Neurology McGovern Medical School at UTHealth TX (Author)
  • Pekka Virtanen - , Helsinki University Hospital (HUS) (Author)
  • Lieselotte Vandewalle - , Laboratory for Neurobiology (Author)
  • Anke Wouters - , Laboratory for Neurobiology (Author)
  • Jessica Jesser - , University Hospital Heidelberg (Author)
  • Rita Ventura - , Western Lisbon Hospital Centre (CHLO) (Author)
  • Alicia C Castonguay - , University of Toledo (Author)
  • Kazutaka Uchida - , Hyogo Medical University (Author)
  • Ajit S Puri - , University of Massachusetts Memorial Medical Center (A.S.P.) (Author)
  • Hesham E Masoud - , State University of New York (H.E.M.) (Author)
  • Piers Klein - , Boston Medical Center (BMC) (Author)
  • Zain Mansoor - , Boston Medical Center (BMC) (Author)
  • Jenny Bui - , Boston Medical Center (BMC) (Author)
  • Matthew Kang - , Boston Medical Center (BMC) (Author)
  • Adnan Mujanovic - , Inselspital University Hospital Bern (Author)
  • Federica Rizzo - , Vall d'Hebron University Hospital (Author)
  • Tatu Kokkonen - , Helsinki University Hospital (HUS) (Author)
  • João Nuno Ramos - , Western Lisbon Hospital Centre (CHLO) (Author)
  • Davide Strambo - , University Hospital of Lausanne (Author)
  • Patrik Michel - , University Hospital of Lausanne (Author)
  • Markus A Möhlenbruch - , University Hospital Heidelberg (Author)
  • Eugene Lin - , Bon Secours Mercy Health St Vincent Hospital (Author)
  • Daniel P O Kaiser - , Dresden Neurovascular Center, Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus Dresden (Author)
  • Shinichi Yoshimura - , Hyogo Medical University (Author)
  • Nobuyuki Sakai - , Kobe City Medical Center General Hospital (Author)
  • Charlotte Cordonnier - , Université de Lille (Author)
  • Peter A Ringleb - , University Hospital Heidelberg (Author)
  • Daniel Roy - , Centre Hospitalier de l'Université de Montreal (CHUM) (Author)
  • Osama O Zaidat - , Bon Secours Mercy Health St Vincent Hospital (Author)
  • Urs Fischer - , University Hospital Basel (Author)
  • Marc Ribo - , Vall d'Hebron University Hospital (Author)
  • Jean Raymond - , Centre Hospitalier de l'Université de Montreal (CHUM) (Author)
  • Raul G Nogueira - , Grady Memorial Hospital (D.C.H (Author)
  • Thanh N Nguyen - , Boston Medical Center (BMC) (Author)

Abstract

BACKGROUND: The association between sex and outcome after endovascular thrombectomy of acute ischemic stroke is unclear. The aim of this study was to compare the clinical and safety outcomes between men and women treated with endovascular thrombectomy in the late 6-to-24-hour window period.

METHODS: This multicenter, retrospective observational cohort study included consecutive patients who underwent endovascular thrombectomy of anterior circulation stroke in the late window from 66 clinical sites in 10 countries from January 2014 to May 2022. The primary outcome was the 90-day ordinal modified Rankin Scale score. Secondary outcomes included 90-day functional independence (FI), return of Rankin (RoR) to prestroke baseline, FI or RoR, symptomatic intracranial hemorrhage, and mortality. Multivariable and inverse probability of treatment weighting methods were used. We explored the interaction of sex with baseline characteristics on the outcomes ordinal modified Rankin Scale and FI or RoR.

RESULTS: Of 1932 patients, 1055 were women and 877 were men. Women were older (77 versus 69 years), had higher rates of atrial fibrillation, hypertension, and greater prestroke disability, but there was no difference in baseline National Institutes of Health Stroke Scale score. Inverse probability of treatment weighting analysis showed no difference between women and men in ordinal modified Rankin Scale (odds ratio, 0.98 [95% CI, 0.79-1.21]), FI or RoR (odds ratio, 0.98 [95% CI, 0.78-1.22]), severe disability or mortality (odds ratio, 0.99 [95% CI, 0.80-1.23]). The multivariable analysis of the above end points was concordant. There were no interactions between baseline characteristics and sex on the outcomes of ordinal modified Rankin Scale and FI or RoR.

CONCLUSIONS: In late presenting patients with anterior circulation stroke treated with endovascular thrombectomy in the 6 to 24-hour window, there was no difference in clinical or safety outcomes between men and women.

Details

Original languageEnglish
Pages (from-to)278-287
Number of pages10
JournalStroke
Volume55
Issue number2
Publication statusPublished - Feb 2024
Peer-reviewedYes

External IDs

ORCID /0000-0001-5258-0025/work/151438178
Scopus 85183249101

Keywords

Keywords

  • United States, Humans, Ischemic Stroke, Female, Male, Retrospective Studies, Sex Characteristics, Atrial Fibrillation, Stroke/surgery

Library keywords