학술논문
Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study.
Document Type
Academic Journal
Author
Casetta I; Clinical Neurology, University of Ferrara, Ferrara, Italy.; Fainardi E; University of Florence, Florence, Italy.; Pracucci G; University of Florence, Florence, Italy.; Saia V; Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy.; Sallustio F; Ospedale dei Castelli-ASL, RM, Ariccia, Italy.; da Ros V; University of Rome Tor Vergata, RM, Roma, Italy.; Nappini S; Careggi University Hospital, Florence, Italy.; Nencini P; Careggi University Hospital, Florence, Italy.; Bigliardi G; University Hospital Modena, Modena, Italy.; Vinci S; University of Messina, Messina, Italy.; Grillo F; University of Messina, Messina, Italy.; Bracco S; Santa Maria alle Scotte Hospital, Siena, Italy.; Tassi R; Santa Maria alle Scotte Hospital, Siena, Italy.; Bergui M; University of Turin, Torino, Italy.; Cerrato P; AOU Città della Salute, Torino, Italy.; Saletti A; Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.; De Vito A; Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.; Gasparotti R; University of Brescia, Brescia, Italy.; Magoni M; Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy.; Simonetti L; Ospedale Maggiore, Bologna, Italy.; Zini A; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.; Ruggiero M; Bufalini Hospital, Cesena, Italy.; Longoni M; Bufalini Hospital, Cesena, Italy.; Castellan L; IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Malfatto L; IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Castellini P; Ospedale Maggiore di Parma, Parma, Italy.; Cosottini M; University of Pisa, Pisa, Italy.; Comai A; Bolzano Hospital, Bolzano, Italy.; Franchini E; Bolzano Hospital, Bolzano, Italy.; Lozupone E; Hospital Fazzi, Lecce, Italy.; Della Marca G; University Hospital Agostino Gemelli, RM, Roma, Italy.; Puglielli E; ASL 4 Teramo, Teramo, Italy.; Casalena A; ASL 4 Teramo, Teramo, Italy.; Baracchini C; University of Padua, Padua, Italy.; Savio D; Ospedale San Giovanni Bosco, Torino, Italy.; Duc E; Ospedale San Giovanni Bosco, Torino, Italy.; Ricciardi G; AOUI Verona, Verona, Italy.; Cappellari M; AOUI Verona, Verona, Italy.; Chiumarulo L; University of Bari, Bari, Italy.; Petruzzellis M; University of Bari, Bari, Italy.; Cavallini A; IRCCS Fondazione C. Mondino, Pavia, Italy.; Cavasin N; Ospedale dell'Angelo, Mestre, Italy.; Critelli A; Ospedale dell'Angelo, Mestre, Italy.; Burdi N; AO SS. Annunziata, Taranto, Italy.; Boero G; AO SS. Annunziata, Taranto, Italy.; Giorgianni A; ASST Sette Laghi, Varese, Italy.; Versino M; University of Insubria, Varese, Italy.; Biraschi F; University of Rome La Sapienza, RM, Roma, Italy.; Nicolini E; University of Rome La Sapienza, RM, Roma, Italy.; Comelli S; Ospedale Botzu, Cagliari, Italy.; Melis M; Ospedale Botzu, Cagliari, Italy.; Padolecchia R; Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy.; Tassinari T; Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy.; Paolo Nuzzi N; IRCCS Humanitas Research Hospital, Milan, Italy.; Marcheselli S; IRCCS Humanitas Research Hospital, Milan, Italy.; Sacco S; University of L'Aquila, L' Aquila, Italy.; Invernizzi P; Fondazione Poliambulanza, Brescia, Italy.; Gallesio I; Ospedale Casale Monferrato, Alessandria, Italy.; Ferrandi D; Ospedale Casale Monferrato, Alessandria, Italy.; Fancello M; Hospital San Francesco, Nuoro, Italy.; Valeria Saddi M; Hospital San Francesco, Nuoro, Italy.; Russo M; Ospedale Rovigo, Rovigo, Italy.; Pischedda A; AOU Sassari, Sassari, Italy.; Baule A; AOU Sassari, Sassari, Italy.; Mannino M; Palermo Hospital, Palermo, Italy.; Florio F; Fondazione di Religione e di Culto Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.; Inchingolo V; Fondazione di Religione e di Culto Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.; Elena Flacco M; University of Ferrara, Ferrara, Italy.; Romano D; AOU S. Giovanni di Dio Ruggi D'Aragona, Salerno, Italy.; Silvagni U; AO Cosenza, Cosenza, Italy.; Inzitari D; University of Florence, Florence, Italy.; Mangiafico S; Careggi University Hospital, Florence, Italy.; Toni D; University of Rome La Sapienza, RM, Roma, Italy.
Source
Publisher: SAGE Publications Ltd Country of Publication: England NLM ID: 101688446 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2396-9881 (Electronic) Linking ISSN: 23969873 NLM ISO Abbreviation: Eur Stroke J Subsets: PubMed not MEDLINE
Subject
Language
English
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.
Competing Interests: 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.
(© European Stroke Organisation 2022.)
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.
Competing Interests: 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.
(© European Stroke Organisation 2022.)