Future efforts should focus on designing and evaluating interventions to improve sex disparities, researcher says.
Sex differences in the outcomes of mechanical thrombectomy exist beyond those explained by vessel recanalization or in-hospital complications, according to a prospective, single-center study published online August 10, 2018, ahead of print in the Journal of NeuroInterventional Surgery.
“We know that, in general, women have worse outcomes after stroke,” lead author Tracy E. Madsen, MD (University Emergency Medicine Foundation/Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI), told Neurovascular Exchange in an email. “Mechanical thrombectomy has been shown to be an effective option for many patients with large vessel occlusion [LVO] stroke, but it is generally unknown whether use of this intervention helps to decrease the difference in post-stroke outcomes between women and men.”
Madsen and colleagues conducted a prospective cohort study of 279 adults with LVO treated with mechanical thrombectomy at a single academic comprehensive stroke center between July 2015 to April 2017.
Among these patients, 52% were female. The female patients were older than the male patients (median 81 vs 71.5 years of age; P < 0.001) and had higher baseline NIHSS score (18.2 ± 7.5 vs 16.0 ± 7.1; P = 0.02). The two groups were similar, however, with regard to the proportion with a prestroke mRS ≤ 2 (73.3% vs 67.1%; P = 0.27).
Multivariate analysis that controlled for demographics, stroke severity, prestroke functional status, the presence of comorbidities, time from symptom onset to thrombectomy, TICI score ≥ 2b, and use of intravenous tPA revealed that while both men and women had an equal likelihood of being independent at discharge, women were less likely than men to be independent at 90 days.
Independence at Discharge and 90 Days: Women vs Men
|
|
Adjusted Odds Ratio (95% CI) |
P Value |
|
Independence at Discharge |
0.71 (0.32-1.58) |
0.41 |
|
Independence at 90 Days |
0.37 (0.16-0.87) |
0.02 |
Madsen emphasized the fact that the differences were seen even after adjusting for age, level of independence prestroke, stroke severity, vessel recanalization, and medical comorbidities.
Reasons for Difference Remain Elusive
“Our study was not able to identify why these sex differences occur,” indicated Madsen. “There may very well be differences between women and men that are harder to measure but contribute to these outcomes,” she noted. “These include social isolation, less physical reserve (related to the idea of being frail), mental health, and other chronic medical problems like musculoskeletal disorders.”
In addition, she said it remains an open question as to which “interventions might be effective to improve these disparities in outcomes. Future research should focus on designing and evaluating the effectiveness of such interventions.”
For now, Madsen added, clinicians should be sure to offer both male and female patients the most effective therapies for acute stroke, which include both tPA and mechanical thrombectomy, when indicated.
She also recommended that “more attention should be paid to factors post-stroke, both in the hospital and after stroke, that may affect outcomes, including isolation and post-stroke depression among the demographic of older women.”
Source:
Madsen TE, DeCroce-Movson E, Hemendinger M, et al. Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke. J NeuroIntervent Surg. 2018;Epub ahead of print.
Disclosures:
Madsen reports no relevant conflicts of interest.
