Are there differences in the prognosis of patients with large vessel occlusive stroke? Gender Difference丨ISC2021

Studies have shown that after acute ischemic stroke (AIS) thrombolytic therapy, women have a higher degree of disability than men.

However, it is controversial whether the results of endovascular treatment (EVT) in patients with large vessel occlusive acute stroke differ by gender.

Therefore, American scholar Johanna T Fifi et al.
compared the gender differences in EVT results and evaluated the relationship with improvement after discharge.

The results will be announced at the International Stroke Conference 2021 (ISC2021) in the form of a poster summary.

Author: Medical team doctors report NMT NMT ISC finishing compiler, please do not reprint without authorization.

Study Introduction In the prospective cohort of SELECT, the researchers continuously included patients with anterior circulation large vessel occlusion treated with EVT within 24 hours of the onset of onset in 9 centers, and stratified them by gender, and analyzed the discharge outcome of all patients, 90 Tian mRS was compared and propensity matching analysis was carried out at the same time.

A repeated measures mixed regression model with linear approximation to mRS was used to evaluate mRS improvement (from hospital discharge to 90 days).

Main findings ➤ Among the 285 patients, 139 (48.
8%) were women, aged ≥69 years (mean IQR 69 years (57, 81) vs 65 (56, 75), p=0.
04), with similar NIHSS ( 17(11,22) vs 16(12,20), p=0.
44).

➤Women have smaller perfusion lesions on CTA/CTP 109 (66151) vs 154 (104198) cc, p<0.
001) and better collateral circulation, but the ischemic core volume is similar 8 (0,25) compared to 11 (0,38)cc, p=0.
22. ➤The independent rate of discharge function between the two groups was similar in average (IQR) mRS scores (39% for women vs 46% for men, p=0.
14; MRS: 3 vs.
3, p=0.
43).

There was no difference in mRS 0-2 between men and women at 90 days (50% vs 55%, AOR 0.
77, 95% CI 0.
39-1.
50, p=0.
39), average (IQR) MRS: 2(1, 4) vs 2(0 , 4).

➤Men (2.
62 vs 2.
21, down 0.
41) vs women (2.
65 vs 2.
46, down: 0.
19, p=0.
21) have a greater tendency to improve mRS scores, as shown in Figure 2A.

Among the 65 pairs that tend to be paired, women's 90-day mRS 0-2 was worse (46% vs 60%, aOR 0.
41, 95% CI 0.
16-1.
00, p=0.
05).

The improvement in mRS from hospital discharge to 90 days was significantly greater in men (2.
49 vs 1.
88, 0.
61 vs.
women 2.
52 vs 2.
44, and 0.
08 reduction, p=0.
04), although discharge was similar, see Figure 2B.

Figure 1 depicts the distribution of MRS scores at discharge, and the 90-day follow-up stratified by gender, A) overall EVT cohort, and B) propensity pairing.

 Figure 2 illustrates the expected improvement in MRS scores from discharge to the 90-day follow-up period, A) the overall EVT cohort, and B) propensity pairing adjusted for potential confounding factors.

In the overall cohort, men showed a trend of greater improvement from discharge to 90 days (Figure 2A).
In terms of pairing tendency, the improvement of men was significantly greater than that of women.
Conclusion The discharge rate of women after EVT was similar to that of men, but their function improved after 90 days.
Obviously worse.

It is necessary to further explore the influencing factors after discharge to determine the target intervention measures.

Yimaitong compiled from: Sex Differences in Clinical Outcomes After Endovascular Thrombectomy for Large Vessel Occlusion Stroke: A Sub-Analysis of the SELECT Study.
ISC2021.
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