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Sex Differences in Collateral Circulation and Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke

Lagebrant, Christian ; Ramgren, Birgitta LU ; Hassani Espili, Ashkan ; Marañon, Antonio LU and Kremer, Christine LU (2022) In Frontiers in Neurology 13.
Abstract
Background: Collateral circulation is known to lead to smaller infarct volume and better functional outcome after mechanical thrombectomy (MT), but studies examining sex differences in collateral circulation are scarce. The aim of this study was to investigate if collateral circulation has a different impact on outcome in women and men.
Methods: A single-center retrospective study of 487 patients (230 men and 257 women) treated with MT for acute ischemic stroke in the anterior cerebral circulation. Collateral circulation was assessed on computed tomography angiography images. The outcome was evaluated at 90 days according to the modified Rankin Scale (mRS).
Results: Women were older, median age 76 years (IQR 68-83) vs. 71 years... (More)
Background: Collateral circulation is known to lead to smaller infarct volume and better functional outcome after mechanical thrombectomy (MT), but studies examining sex differences in collateral circulation are scarce. The aim of this study was to investigate if collateral circulation has a different impact on outcome in women and men.
Methods: A single-center retrospective study of 487 patients (230 men and 257 women) treated with MT for acute ischemic stroke in the anterior cerebral circulation. Collateral circulation was assessed on computed tomography angiography images. The outcome was evaluated at 90 days according to the modified Rankin Scale (mRS).
Results: Women were older, median age 76 years (IQR 68-83) vs. 71 years (IQR 63–78). Stroke severity and time to recanalization were comparable. More women had moderate or good collaterals in 58.4 vs. 47.0% for men (p = 0.01). Among patients with moderate and good collaterals significantly more men (61%) were functionally independent (mRS 0–2) than women (41.5%) (p = < 0.01). This difference remained significant after correcting for age by linear weighting, 60.4 vs. 46.8% (p = 0.03).
Conclusion: Women had better collateral flow but showed worse functional outcomes, while good collateral flow led to better outcomes in men, even after correcting for age. Further clinical studies on peri- and post-interventional care, factors affecting recovery after hospital discharge as well as basic research on the neurovascular unit are needed to find modifiable targets to improve clinical outcomes for women. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Frontiers in Neurology
volume
13
article number
878759
publisher
Frontiers Media S. A.
external identifiers
  • scopus:85131744816
  • pmid:35665053
ISSN
1664-2295
DOI
10.3389/fneur.2022.878759
project
Könsskillnader i behandlingsresultat och hälsotillstånd efter akut strokebehandling
language
English
LU publication?
yes
id
581f6c7a-d195-47d8-9a38-1ac8363ba39a
date added to LUP
2022-05-27 13:01:30
date last changed
2024-01-18 09:30:05
@article{581f6c7a-d195-47d8-9a38-1ac8363ba39a,
  abstract     = {{Background: Collateral circulation is known to lead to smaller infarct volume and better functional outcome after mechanical thrombectomy (MT), but studies examining sex differences in collateral circulation are scarce. The aim of this study was to investigate if collateral circulation has a different impact on outcome in women and men.<br/>Methods: A single-center retrospective study of 487 patients (230 men and 257 women) treated with MT for acute ischemic stroke in the anterior cerebral circulation. Collateral circulation was assessed on computed tomography angiography images. The outcome was evaluated at 90 days according to the modified Rankin Scale (mRS).<br/>Results: Women were older, median age 76 years (IQR 68-83) vs. 71 years (IQR 63–78). Stroke severity and time to recanalization were comparable. More women had moderate or good collaterals in 58.4 vs. 47.0% for men (p = 0.01). Among patients with moderate and good collaterals significantly more men (61%) were functionally independent (mRS 0–2) than women (41.5%) (p = &lt; 0.01). This difference remained significant after correcting for age by linear weighting, 60.4 vs. 46.8% (p = 0.03).<br/>Conclusion: Women had better collateral flow but showed worse functional outcomes, while good collateral flow led to better outcomes in men, even after correcting for age. Further clinical studies on peri- and post-interventional care, factors affecting recovery after hospital discharge as well as basic research on the neurovascular unit are needed to find modifiable targets to improve clinical outcomes for women.}},
  author       = {{Lagebrant, Christian and Ramgren, Birgitta and Hassani Espili, Ashkan and Marañon, Antonio and Kremer, Christine}},
  issn         = {{1664-2295}},
  language     = {{eng}},
  month        = {{05}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Neurology}},
  title        = {{Sex Differences in Collateral Circulation and Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke}},
  url          = {{https://lup.lub.lu.se/search/files/119106247/fneur_13_878759_3_.pdf}},
  doi          = {{10.3389/fneur.2022.878759}},
  volume       = {{13}},
  year         = {{2022}},
}