采用血管内血栓切除术治疗大血管闭塞患者在血块、血管和组织特征方面的性别差异。

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY
European Stroke Journal Pub Date : 2024-09-01 Epub Date: 2024-02-29 DOI:10.1177/23969873241231125
Anne van der Meij, Ghislaine Holswilder, Marie Louise E Bernsen, Hendrikus Ja van Os, Jeannette Hofmeijer, Fianne Hm Spaander, Jasper M Martens, Ido R van den Wijngaard, Hester F Lingsma, Praneeta R Konduri, Charles Blm Majoie, Wouter J Schonewille, Diederik Wj Dippel, Nyika D Kruyt, Paul J Nederkoorn, Marianne Aa van Walderveen, Marieke Jh Wermer
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引用次数: 0

摘要

简介:为了更好地了解女性接受血管内治疗(EVT)后相对较差的预后,我们评估了患有前方大血管闭塞(LVO)的急性缺血性卒中患者基线神经影像学特征中可能存在的性别差异:我们纳入了MR CLEAN注册中心在2014年至2017年间接受EVT治疗的所有连续患者。在基线非对比 CT 和 CT 血管造影中,我们用阿尔伯塔省卒中计划早期计算机断层扫描评分(ASPECTS)评估了血栓位置和血栓负担评分(CBS)、血管特征(是否存在动脉粥样硬化、迂曲、大小和侧支状态)以及组织特征。放射学结果采用脑梗塞扩大溶栓评分(eTICI)进行评估,功能结果采用 90 天的改良 Rankin 量表评分(mRS)进行评估。通过多变量回归分析评估了性别差异,并对可能的混杂因素进行了调整:共纳入 3180 名患者(中位年龄 72 岁,48% 为女性)。女性血栓较少位于颅内颈内动脉(ICA)(25%对28%,几率比(OR)0.85;95%置信区间:0.73-1.00)。不同性别的 CBS 相似(中位数为 6,IQR 为 4-8)。女性颅内(aOR 0.73;95% CI:0.62-0.87)和颅外(aOR 0.64;95% CI:0.43-0.95)动脉粥样硬化的发生率较低。女性的颈部主动脉瓣血管迂曲更常见(aOR 1.89;95% CI:1.39-2.57),女性主动脉弓严重伸长更常见(aOR 1.38;95% CI:1.00-1.91)。女性的 ICA 半径较小(2.3vs 2.5 mm,平均差异为 0.22;95% CI:0.09-0.35),而 M1 半径基本相同(1.6vs 1.7 mm,平均差异为 0.09;95% CI:-0.02-0.21)。女性的侧支状况更好(62%的女性侧支充盈率为50%,而男性为53%,aOR值为1.48;95% CI:1.29-1.70)。最后,女性和男性的 ASPECT 评分相同(男女中位数均为 9,IQR 为 8-10vs 9-10)。女性和男性的再灌注率相似(acOR 0.94;95% CI:0.83-1.07)。然而,女性达到功能独立的比例低于男性(34%vs 46%,aOR 0.68;95% CI:0.53-0.86):讨论与结论:在这项荷兰登记的基线成像中,患有左心室积水的男性和女性主要在血管特征(如动脉粥样硬化负荷、颅外血管迂曲度和侧支状态)上存在差异。这些性别差异不会导致再灌注率的不同,因此不太可能解释女性在接受 EVT 后功能预后较差的原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy.

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.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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