Sex-Related Differences in Outcomes of Endovascular Treatment in Large Vessel Occlusion Stroke—Analyses From the German Stroke Registry-Endovascular Treatment

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY European Journal of Neurology Pub Date : 2025-02-26 DOI:10.1111/ene.70092

Constanze Single, Annerose Mengel, Kornelia Laichinger, Jennifer Sartor-Pfeiffer, Nadja Selo, Florian Hennersdorf, Benjamin Bender, Milani Deb-Chatterji, Götz Thomalla, Joshua Mbroh, Sven Poli, Ulf Ziemann, Ulrike Ernemann, Katharina Feil, German Stroke Registry—Endovascular Treatment (GSR)

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Abstract

Background

Sex-related differences in acute ischemic stroke may affect outcomes, yet evidence remains inconsistent. This large-scale study investigated sex-related differences in clinical presentation, peri-interventional parameters, and outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) using data from the German Stroke Registry—Endovascular Treatment (GSR-ET).

Methods

We analyzed 11.896 EVT patients (52.2% female) from the GSR-ET (June 2015–December 2021) comparing clinical characteristics, treatment details, and outcomes by sex. Two propensity score matchings (PSM) were applied: (1) logistic regression model with a caliper width of 0.1 on age, pre-stroke modified Rankin Scale (pmRS), and National Institutes of Health Stroke Scale at admission, and (2) 1:1 nearest neighbor matching with a caliper of 0.01. Primary outcomes were good (mRS 0–2) and excellent (mRS 0–1) outcomes at discharge and 90-day follow-up.

Results

Women were older (76.3 ± 12.7 vs. 70.2 ± 12.9 years, p < 0.001) and had higher pre-stroke disability (median pmRS 0 (0, 2) vs. 0 (0, 1), p < 0.001). Cardioembolic strokes were more frequent in women, even after PSM. Despite this, women had better odds of achieving good outcomes at discharge (adjusted OR 1.20, 95% CI 1.04–1.38, p = 0.013), but not at follow-up (OR 0.91, 95% CI 0.78–1.05, p = 0.193). Both PSM analyses confirmed these findings.

Conclusions

While women demonstrated better short-term functional outcomes after EVT, these benefits diminished in follow-up. The persistence of cardioembolic stroke in women suggests potential sex-specific mechanisms. Understanding and addressing sex-related differences in stroke is essential to optimize acute stroke care and improve outcomes. Future studies should explore biological and socio-economic factors influencing sex-related differences.

Trial Registration

ClinicalTrials.gov identifier: NCT03356392

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大血管闭塞性卒中血管内治疗结果的性别差异——来自德国卒中登记的分析——血管内治疗

背景：急性缺血性卒中的性别差异可能影响预后，但证据仍不一致。这项大规模研究利用德国卒中登记-血管内治疗（GSR-ET）的数据，调查了大血管闭塞（LVO）的血管内取栓（EVT）后临床表现、介入期参数和结局的性别差异。方法我们分析了2015年6月至2021年12月期间来自GSR-ET的11.896例EVT患者（52.2%为女性），按性别比较临床特征、治疗细节和结局。采用两种倾向评分匹配（PSM）方法：(1)采用年龄时卡尺宽度为0.1的logistic回归模型，卒中前修正Rankin量表（pmRS）和国立卫生研究院卒中量表（nih卒中量表）；(2)采用1:1最近邻匹配，卡尺宽度为0.01。出院和90天随访时，主要结局为良好（mRS 0-2）和优异（mRS 0-1）。结果女性年龄较大（76.3±12.7岁vs. 70.2±12.9岁，p < 0.001），卒中前残疾较高(中位pmr为0 （0,2)vs. 0 (0,1), p < 0.001）。心脏栓塞性中风在女性中更常见，即使在PSM之后也是如此。尽管如此，女性在出院时获得良好结果的几率更高（调整OR为1.20,95% CI 1.04-1.38, p = 0.013），但在随访时则不然（OR为0.91,95% CI 0.78-1.05, p = 0.193）。两项PSM分析都证实了这些发现。结论：尽管女性在EVT后表现出较好的短期功能结果，但这些益处在随访中减弱。女性心脏栓塞性中风的持续存在提示了潜在的性别特异性机制。了解和解决卒中的性别相关差异对于优化急性卒中护理和改善预后至关重要。未来的研究应探索影响性别相关差异的生物和社会经济因素。试验注册ClinicalTrials.gov标识符：NCT03356392

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).