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. 2022 Jun;7(2):151-157.
doi: 10.1177/23969873221091648. Epub 2022 Apr 7.

Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study

Ilaria Casetta  1 , Enrico Fainardi  2 , Giovanni Pracucci  2 , Valentina Saia  3 , Fabrizio Sallustio  4 , Valerio da Ros  5 , Sergio Nappini  6 , Patrizia Nencini  6 , Guido Bigliardi  7 , Sergio Vinci  8 , Francesco Grillo  8 , Sandra Bracco  9 , Rossana Tassi  9 , Mauro Bergui  10 , Paolo Cerrato  11 , Andrea Saletti  12 , Alessandro De Vito  12 , Roberto Gasparotti  13 , Mauro Magoni  14 , Luigi Simonetti  15 , Andrea Zini  16 , Maria Ruggiero  17 , Marco Longoni  17 , Lucio Castellan  18 , Laura Malfatto  18 , Paola Castellini  19 , Mirco Cosottini  20 , Alessio Comai  21 , Enrica Franchini  21 , Emilio Lozupone  22 , Giacomo Della Marca  23 , Edoardo Puglielli  24 , Alfonsina Casalena  24 , Claudio Baracchini  25 , Daniele Savio  26 , Enrica Duc  26 , Giuseppe Ricciardi  27 , Manuel Cappellari  27 , Luigi Chiumarulo  28 , Marco Petruzzellis  28 , Anna Cavallini  29 , Nicola Cavasin  30 , Adriana Critelli  30 , Nicola Burdi  31 , Giovanni Boero  31 , Andrea Giorgianni  32 , Maurizio Versino  33 , Francesco Biraschi  34 , Ettore Nicolini  34 , Simone Comelli  35 , Maurizio Melis  35 , Riccardo Padolecchia  3 , Tiziana Tassinari  3 , Nunzio Paolo Nuzzi  36 , Simona Marcheselli  36 , Simona Sacco  37 , Paolo Invernizzi  38 , Ivan Gallesio  39 , Delfina Ferrandi  39 , Maria Fancello  40 , Maria Valeria Saddi  40 , Monia Russo  41 , Aldo Pischedda  42 , Antonio Baule  42 , Marina Mannino  43 , Francesco Florio  44 , Vincenzo Inchingolo  44 , Maria Elena Flacco  45 , Daniele Romano  46 , Umberto Silvagni  47 , Domenico Inzitari  2 , Salvatore Mangiafico  6 , Danilo Toni  34 ; Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS)
Affiliations

Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study

Ilaria Casetta et al. Eur Stroke J. 2022 Jun.

Abstract

Background and purpose: We sought to investigate whether there are gender differences in clinical outcome after stroke due to large vessel occlusion (LVO) after mechanical thrombectomy (EVT) in a large population of real-world patients.

Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke due to large vessel occlusion. We compared clinical and safety outcomes in men and women who underwent EVT alone or in combination with intravenous thrombolysis (IVT) in the total population and in a Propensity Score matched set.

Results: Among 3422 patients included in the study, 1801 (52.6%) were women. Despite older age at onset (mean 72.4 vs 68.7; p < 0.001), and higher rate of atrial fibrillation (41.7% vs 28.6%; p < 0.001), women had higher probability of 3-month functional independence (adjusted odds ratio-adjOR 1.19; 95% CI 1.02-1.38), of complete recanalization (adjOR 1.25; 95% CI 1.09-1.44) and lower probability of death (adjOR 0.75; 95% CI 0.62-0.90). After propensity-score matching, a well-balanced cohort comprising 1150 men and 1150 women was analyzed, confirming the same results regarding functional outcome (3-month functional independence: OR 1.25; 95% CI 1.04-1.51), and complete recanalization (OR 1.29; 95% CI 1.09-1.53).

Conclusions: Subject to the limitations of a non-randomized comparison, women with stroke due to LVO treated with mechanical thrombectomy had a better chance to achieve complete recanalization, and 3-month functional independence than men. The results could be driven by women who underwent combined treatment.

Keywords: Ischemic stroke; sex; thrombectomy.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MB: Consultant for Penumbra Inc., Stryker Italia; AS: Consultant for Stryker; ADV: Consultant for Boehringer Ingelheim, Daichi Sankyo; AZ: speaker fees and consulting fees from Boehringer-Ingelheim, Medtronic, Cerenovus and advisory board from Daiichi Sankyo and Boehringer-Ingelheim and Stryker; MC: speaker fees and consulting fees from Daiichi Sankyo and Bristol Myers Squibb, advisory board from Boehringer-Ingelheim; NPN: Consultant for Penumbra Inc., Acandis GmbH; SS: personal fees and non-financial support from Allergan, Abbott, Eli Lilly, Novartis, TEVA, participation to Advisory Board for Astra Zeneca, and research support from Laborest; AM: Consultant for Boehringer Ingelheim, DR: Proctor for Penumbra. Other Authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
The forest plot shows gender comparisons in outcome of PS-matched patients treated either with EVT alone or combined treatment (IVT and EVT). The squares with horizontal lines are adjusted odds ratios (OR) and corresponding 95% confidence interval (95% CI). The right column shows p values for interaction.
See this image and copyright information in PMC

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