Sex-Related Differences in Outcomes of Endovascular Treatment in Large Vessel Occlusion Stroke—Analyses From the German Stroke Registry-Endovascular Treatment

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2025-02-26 DOI:10.1111/ene.70092

Constanze Single, Annerose Mengel, Kornelia Laichinger, Jennifer Sartor-Pfeiffer, Nadja Selo, Florian Hennersdorf, Benjamin Bender, Milani Deb-Chatterji, Götz Thomalla, Joshua Mbroh, Sven Poli, Ulf Ziemann, Ulrike Ernemann, Katharina Feil, German Stroke Registry—Endovascular Treatment (GSR)

{"title":"Sex-Related Differences in Outcomes of Endovascular Treatment in Large Vessel Occlusion Stroke—Analyses From the German Stroke Registry-Endovascular Treatment","authors":"Constanze Single, Annerose Mengel, Kornelia Laichinger, Jennifer Sartor-Pfeiffer, Nadja Selo, Florian Hennersdorf, Benjamin Bender, Milani Deb-Chatterji, Götz Thomalla, Joshua Mbroh, Sven Poli, Ulf Ziemann, Ulrike Ernemann, Katharina Feil, German Stroke Registry—Endovascular Treatment (GSR)","doi":"10.1111/ene.70092","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Sex-related differences in acute ischemic stroke may affect outcomes, yet evidence remains inconsistent. This large-scale study investigated sex-related differences in clinical presentation, peri-interventional parameters, and outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) using data from the German Stroke Registry—Endovascular Treatment (GSR-ET).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We analyzed 11.896 EVT patients (52.2% female) from the GSR-ET (June 2015–December 2021) comparing clinical characteristics, treatment details, and outcomes by sex. Two propensity score matchings (PSM) were applied: (1) logistic regression model with a caliper width of 0.1 on age, pre-stroke modified Rankin Scale (pmRS), and National Institutes of Health Stroke Scale at admission, and (2) 1:1 nearest neighbor matching with a caliper of 0.01. Primary outcomes were good (mRS 0–2) and excellent (mRS 0–1) outcomes at discharge and 90-day follow-up.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Women were older (76.3 ± 12.7 vs. 70.2 ± 12.9 years, <i>p</i> < 0.001) and had higher pre-stroke disability (median pmRS 0 (0, 2) vs. 0 (0, 1), <i>p</i> < 0.001). Cardioembolic strokes were more frequent in women, even after PSM. Despite this, women had better odds of achieving good outcomes at discharge (adjusted OR 1.20, 95% CI 1.04–1.38, <i>p</i> = 0.013), but not at follow-up (OR 0.91, 95% CI 0.78–1.05, <i>p</i> = 0.193). Both PSM analyses confirmed these findings.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>While women demonstrated better short-term functional outcomes after EVT, these benefits diminished in follow-up. The persistence of cardioembolic stroke in women suggests potential sex-specific mechanisms. Understanding and addressing sex-related differences in stroke is essential to optimize acute stroke care and improve outcomes. Future studies should explore biological and socio-economic factors influencing sex-related differences.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>ClinicalTrials.gov identifier: NCT03356392</p>\n </section>\n </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 3","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70092","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ene.70092","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Sex-related differences in acute ischemic stroke may affect outcomes, yet evidence remains inconsistent. This large-scale study investigated sex-related differences in clinical presentation, peri-interventional parameters, and outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) using data from the German Stroke Registry—Endovascular Treatment (GSR-ET).

Methods

We analyzed 11.896 EVT patients (52.2% female) from the GSR-ET (June 2015–December 2021) comparing clinical characteristics, treatment details, and outcomes by sex. Two propensity score matchings (PSM) were applied: (1) logistic regression model with a caliper width of 0.1 on age, pre-stroke modified Rankin Scale (pmRS), and National Institutes of Health Stroke Scale at admission, and (2) 1:1 nearest neighbor matching with a caliper of 0.01. Primary outcomes were good (mRS 0–2) and excellent (mRS 0–1) outcomes at discharge and 90-day follow-up.

Results

Women were older (76.3 ± 12.7 vs. 70.2 ± 12.9 years, p < 0.001) and had higher pre-stroke disability (median pmRS 0 (0, 2) vs. 0 (0, 1), p < 0.001). Cardioembolic strokes were more frequent in women, even after PSM. Despite this, women had better odds of achieving good outcomes at discharge (adjusted OR 1.20, 95% CI 1.04–1.38, p = 0.013), but not at follow-up (OR 0.91, 95% CI 0.78–1.05, p = 0.193). Both PSM analyses confirmed these findings.

Conclusions

While women demonstrated better short-term functional outcomes after EVT, these benefits diminished in follow-up. The persistence of cardioembolic stroke in women suggests potential sex-specific mechanisms. Understanding and addressing sex-related differences in stroke is essential to optimize acute stroke care and improve outcomes. Future studies should explore biological and socio-economic factors influencing sex-related differences.

Trial Registration

ClinicalTrials.gov identifier: NCT03356392

Abstract Image

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).