Article Text
Abstract
Background It is largely unknown whether functional outcomes after mechanical thrombectomy for large vessel occlusion (LVO) ischemic strokes differ by sex in non-clinical trial populations. We investigated sex differences in 90-day outcomes among ischemic stroke patients receiving mechanical thrombectomy.
Methods This was a prospective cohort of adults treated with mechanical thrombectomy for LVO at a single academic comprehensive stroke center from July 2015 to April 2017. Data on independence (mRS ≤2) at hospital discharge and 90 days were collected prospectively. Multiple logistic regression was used to determine the association between sex and 90-day independence, first adjusting for demographics, pre-stroke mRS, and NIHSS, then by co-morbidities and time to thrombectomy, and finally by vessel recanalization and use of intravenous thrombolysis.
Results We included 279 patients, 52% of whom were female. Compared with males, females were older (median years (IQR) 81 (75–88) vs. 71.5 (60–81), P<0.001) and had higher baseline NIHSS (mean SD 18.2±7.5 vs . 16.0±7.1, P=0.02). Similar proportions of males and females had pre-stroke mRS ≤2 (73.3% vs.67.1%, P=0.27). In multivariate analyses, males and females had a similar likelihood of being independent at discharge (aOR 0.71 (95%CI 0.32 to 1.58)), but females were less likely to be independent at 90 days (aOR 0.37 95% CI 0.16 to 0.87).
Conclusions In patients treated with mechanical thrombectomy for LVOs at a large comprehensive stroke center, females were less likely to be independent at 90 days. Future research should investigate contributors to poor outcomes post-discharge in females with LVOs, along with potential interventions to improve outcomes.
- stroke
- thrombectomy
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Footnotes
Contributors TM is responsible for study conception, design, data acquisition, analysis, interpretation as well as drafting the manuscript and critically revising it. ED and MH contributed to data acquisition and critical revisions of the manuscript. RM, SY, and MJ contributed to study design, data acquisition and interpretation, and critical revisions of the manuscript. SC, KF, AS, and MS contributed to data interpretation and critical revisions of the manuscript. All authors have approved the final manuscript and are accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests MJ is a consultant for Medtronic (minor) and a consultant for Stream Biomedical (minor).
Patient consent Not required.
Ethics approval Rhode Island Hospital Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data is available upon request from the corresponding author.