Stroke: stroke, late time window endovascular therapy, gender or no difference

Gender-related differences in stroke
outcomes have long been discussed in the stroke community .

Existing literature does not support a modifying role of gender on early endovascular therapy (EVT) outcomes, with conflicting results showing that women have worse or neutral outcomes than men

stroke vessel

 

A post hoc analysis of the MR CLEAN trial (a multicenter randomized clinical trial of endovascular therapy in acute ischemic stroke in the Netherlands) showed that women had fewer chances of achieving better functional outcomes and higher mortality than men
.

In contrast, in a pooled analysis of seven clinical trials in the HERMES (High Efficiency Reperfusion Using Multiple Endovascular Devices) collaboration, gender did not affect clinical outcomes or alter EVT treatment among those treated within 6 hours of onset effect

There are few data on gender differences in advanced patients
.

A sub-study of the DEFUSE-3 trial (vascular therapy after imaging assessment of ischemic stroke 3) found that among patients treated 6 to 16 hours after onset, women had worse clinical outcomes in the EVT-treated group

Although clinical characteristics were not stratified by sex, the DAWN trial (Trevo neurointervention for awake and late-occurring strokes with clinical mismatch on DWI or CTP assessments) did not report any gender differences in clinical outcomes for all included patients
.

There are several observations that support a potential role of gender in the outcomes of patients with late versus early stroke, and collateral flow may contribute to this difference
.

Some studies have reported better collateral flow in women

In this context, Mohammed Almekhlafi et al.
, Foothills Medical Centre, Canada, in a real-world multinational cohort, investigated the risk of stroke in stroke patients treated with EVT within 6 to 24 hours of symptom onset or within their last known health condition.
, gender-related differences in imaging features and outcomes
.

The analysis was based on the SOLSTICE Consortium (Selection of Late-Window Stroke for Thrombectomy by Imaging Collateral Extent), an individual patient-level analysis of seven trials and registries
.

Baseline characteristics, 90-day functional independence (modified Rankin Scale score ≤2), mortality, and symptomatic intracranial hemorrhage were compared between women and men

Of the 608 patients who received endovascular therapy, 50.
5% were women
.

Women were older than men (median age 72 vs 68, P=0.

Adjusted outcomes did not differ between women and men
.

127 (43.

Mortality after 90 days (54 [18.
5%] vs 48 [16.
5%]) and symptomatic intracranial hemorrhage (37 [13.
3%] vs 33 [11.
6%]) were similar between women and men
.

Mortality after 90 days (54 [18.
5%] vs 48 [16.
5%]) and symptomatic intracranial hemorrhage (37 [13.
3%] vs 33 [11.
6%]) were similar between women and men
.

There was no sex-age interaction on functional outcomes
.

However, with age, men were more likely to experience death (P-interaction=0.
003) and symptomatic intracranial hemorrhage (P-interaction=0.
017)
.
Gender did not affect the relationship between successful reperfusion and outcome
.

The significance of this study is its finding that in a multicenter analysis of advanced-stage patients receiving endovascular therapy, gender was not associated with functional outcomes
.
However, gender influenced the relationship between age and safety outcomes, with worse outcomes for men with age
.

Gender was not associated with functional outcomes in a multicenter analysis of advanced patients receiving endovascular therapy

 

Original source:
Bala F, Casetta I, Nannoni S, et al.
Sex-Related Differences in Outcomes After Endovascular Treatment of Patients With Late-Window Stroke.
Stroke .
Published online January 5, 2022:STROKEAHA.
121.
037127.
doi:10.
1161/STROKEAHA .
121.
037127

Sex-Related Differences in Outcomes After Endovascular Treatment of Patients With Late-Window Stroke.
Stroke

 

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