Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy.

Autor:	van der Meij A; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., Holswilder G; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Bernsen MLE; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands., van Os HJ; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands., Hofmeijer J; Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.; Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands., Spaander FH; Department of Neurology, Zaans Medical Center, Zaandam, The Netherlands., Martens JM; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands., van den Wijngaard IR; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands., Lingsma HF; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Konduri PR; Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., Blm Majoie C; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., Schonewille WJ; Department of Neurology, Sint Antonius Hospital, Nieuwegein, The Netherlands., Dippel DW; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Kruyt ND; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands., Nederkoorn PJ; Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., van Walderveen MA; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Wermer MJ; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2024 Sep; Vol. 9 (3), pp. 600-612. Date of Electronic Publication: 2024 Feb 29.
DOI:	10.1177/23969873241231125
Abstrakt:	Introduction: To improve our understanding of the relatively poor outcome after endovascular treatment (EVT) in women we assessed possible sex differences in baseline neuroimaging characteristics of acute ischemic stroke patients with large anterior vessel occlusion (LVO). Patients and Methods: We included all consecutive patients from the MR CLEAN Registry who underwent EVT between 2014 and 2017. On baseline non-contrast CT and CT angiography, we assessed clot location and clot burden score (CBS), vessel characteristics (presence of atherosclerosis, tortuosity, size, and collateral status), and tissue characteristics with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Radiological outcome was assessed with the extended thrombolysis in cerebral infarction score (eTICI) and functional outcome with the modified Rankin Scale score (mRS) at 90 days. Sex-differences were assessed with multivariable regression analyses with adjustments for possible confounders. Results: 3180 patients were included (median age 72 years, 48% women). Clots in women were less often located in the intracranial internal carotid artery (ICA) (25%vs 28%, odds ratio (OR) 0.85;95% confidence interval: 0.73-1.00). CBS was similar between sexes (median 6, IQR 4-8). Intracranial (aOR 0.73;95% CI:0.62-0.87) and extracranial (aOR 0.64;95% CI:0.43-0.95) atherosclerosis was less prevalent in women. Vessel tortuosity was more frequent in women in the cervical ICA (aOR 1.89;95% CI:1.39-2.57) and women more often had severe elongation of the aortic arch (aOR 1.38;95% CI:1.00-1.91). ICA radius was smaller in women (2.3vs 2.5 mm, mean difference 0.22;95% CI:0.09-0.35) while M1 radius was essentially equal (1.6vs 1.7 mm, mean difference 0.09;95% CI:-0.02-0.21). Women had better collateral status (⩾50% filling in 62%vs 53% in men, aOR 1.48;95% CI:1.29-1.70). Finally, ASPECT scores were equal between women and men (median 9 in both sexes, IQR 8-10vs 9-10). Reperfusion rates were similar between women and men (acOR 0.94;95% CI:0.83-1.07). However, women less often reached functional independence than men (34%vs 46%, aOR 0.68;95% CI:0.53-0.86). Discussion and Conclusion: On baseline imaging of this Dutch Registry, men and women with LVO mainly differ in vessel characteristics such as atherosclerotic burden, extracranial vessel tortuosity, and collateral status. These sex differences do not result in different reperfusion rates and are, therefore, not likely to explain the worse functional outcome in women after EVT. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: IW reports consulting fees from Philips, and is stockholder and inventor of a patent owned by Neurophyxia; PK is a co-founder and shareholder of in Steps B.V.; and is funded by GEMINI (www.dth-gemini.eu): a European Union’s Horizon research and innovation program (Grant Agreement Number: 101136438) and RadPath AI project (2021191). CM reports grants from TWIN Foundation during the conduct of the study (paid to institution), grants from CVON. Dutch Heart Foundation, grants from European Commission, grants from Healthcare Evaluation Netherlands, grants from Stryker outside the submitted work (paid to institution), and is shareholder of Nico-lab; MJHW reports a Vidi grant [project number 91717337] which is a personal grant from the Netherlands Organization of Scientific Research (NWO/ZonMw) and an Aspasia grant.
Databáze:	MEDLINE
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