Effect of Sex on Outcomes of Mechanical Thrombectomy in Basilar Artery Occlusion: A Multicentre Cohort Study

Abstract

<b><i>Introduction:</i></b> Identifying differences in outcome of basilar artery occlusion (BAO) between males and females may be useful in aiding clinical management. Recent studies have demonstrated widespread underrepresentation of women in acute stroke clinical trials. This international multicentre study aimed to determine sex differences in outcome after mechanical thrombectomy (MT) for patients with acute BAO. <b><i>Methods:</i></b> We performed a retrospective analysis of consecutive patients with BAO who had undergone MT in seven stroke centres across five countries (Singapore, Taiwan, United Kingdom, Sweden, and Germany), between 2015 and 2020. Primary outcome was a favourable functional outcome measured by a modified Ranking Scale (mRS) of 0–3 at 90 days. Secondary outcomes were mRS 0–3 upon discharge, mortality, symptomatic intracranial haemorrhage (sICH) and subarachnoid haemorrhage (SAH). <b><i>Results:</i></b> Among the 322 patients who underwent MT, 206 (64.0%) patients were male and 116 (36.0%) were female. Females were older than males (mean ± SD 70.9 ± 14.3 years vs. 65.6 ± 133.6 years; <i>p</i> = 0.001) and had higher rates of atrial fibrillation (38.9% vs. 24.2%; <i>p</i> = 0.012). Time from groin puncture to reperfusion was shorter in females than males (mean ± SD 57.2 ± 37.2 min vs. 71.1 ± 50.9 min; <i>p</i> = 0.021). Despite these differences, primary and secondary outcome measures were similar in females and males, with comparable rates of favourable 90-day mRS scores (mean ± SD 46 ± 39.7 vs. 71 ± 34.5; OR = 1.20; 95% confidence interval [CI] = 0.59–2.43; <i>p</i> = 0.611), favourable discharge mRS scores (mean ± SD 39 ± 31.6 vs. 43 ± 25.9; OR = 1.38; 95% CI = 0.69–2.78; <i>p</i> = 0.368) and in-hospital mortality (mean ± SD 30 ± 25.9 vs. 47 ± 22.8; OR = 1.15; 95% CI = 0.55–2.43; <i>p</i> = 0.710. Rates of complications such as sICH (mean ± SD 5 ± 4.3 vs. 9 ± 4.4; OR = 0.46; 95% CI = 0.08–2.66; <i>p</i> = 0.385) and SAH (mean ± SD 4 ± 3.4 vs. 5 ± 2.4; OR = 0.29; 95% CI = 0.03–3.09; <i>p</i> = 0.303) comparably low in both groups. <b><i>Conclusion:</i></b> Females achieved comparable functional outcomes compared with males after undergoing MT for BAO acute ischemic stroke.

Outcomes of Endovascular Therapy in Young Patients with Acute Basilar Artery Occlusion: A Substudy of BASILAR Registry Study

“…Our findings also showed that young female cohorts have high collateral grades (64.52% vs. 59.50%), but the difference between men and women was insignificant. In addition, lower rates of bridge intravenous thrombolysis (19.07% vs. 39.40%), hypertension (59.21% vs. 76.20%), and diabetes (19.07% vs. 28.8%), and shorter onset to puncture time (330 vs. 359.60 mins) were found in young patient in our study compared with a multicenter cohort study [34]. The findings of Guenego et al supported our results as sex was a predictor of mortality in patients with BAO treated with EVT [37].…”

“…Chalos et al [33] also demonstrated that sex could not predict mortality within 90 days in patients who underwent EVT. Among patients with BAO, Tan et al [34] indicated that the functional outcomes were comparable between men and women. One cause of the discrepancy between ours and the aforementioned studies may be the included population.…”

Sex differences in outcomes after endovascular treatment of patients with vertebrobasilar artery occlusion

“…28 A recent study of the effect of sex on the outcome of mechanical thrombectomy in basilar artery occlusion (BAO) showed that women achieved comparable functional outcomes compared with men after undergoing mechanical thrombectomy. 29 However, this is not consistent with our findings. This may involve differences in population, economy, medical level, and other aspects.…”

The Relationship Between Neuron-Specific Enolase and Clinical Outcomes in Patients Undergoing Mechanical Thrombectomy

“…4,45 Another interesting result was that the poor outcome group contained a larger number of female patients compared with the favorable outcome group, which agreed with the finding of a prospective cohort study by Madsen et al 46 This is probably attributed to the older age and higher ratio of atrial fibrillation as well as cardioembolic stroke among the female patients. 47,48 More detailed researches are warranted to ascertain the gender difference in endovascular treatment to help formulate the optimal management. Furthermore, elevated NSE might not just be the result of neuronal injury but also involved in pathological process.…”