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

Author:

van der Meij Anne12ORCID,Holswilder Ghislaine3ORCID,Bernsen Marie Louise E4,van Os Hendrikus JA15,Hofmeijer Jeannette67,Spaander Fianne HM8,Martens Jasper M4ORCID,van den Wijngaard Ido R19,Lingsma Hester F10,Konduri Praneeta R1112ORCID,BLM Majoie Charles12,Schonewille Wouter J13,Dippel Diederik WJ14,Kruyt Nyika D1ORCID,Nederkoorn Paul J2,van Walderveen Marianne AA3,Wermer Marieke JH115

Affiliation:

1. Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands

2. Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

3. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

4. Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands

5. Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands

6. Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands

7. Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands

8. Department of Neurology, Zaans Medical Center, Zaandam, The Netherlands

9. Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands

10. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands

11. Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

12. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

13. Department of Neurology, Sint Antonius Hospital, Nieuwegein, The Netherlands

14. Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

15. Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands

Abstract

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.

Funder

MR CLEAN Registry was partly

Publisher

SAGE Publications

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