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

Benjamin Yong‐Qiang Tan(National University of Singapore), Isabel Siow(National University of Singapore), Keng Siang Lee(University of Bristol), Vanessa Chen(National University Health System), S. K. Ong(National University of Singapore), Anil Gopinathan(National University of Singapore), Cunli Yang(National University of Singapore), Pervinder Bhogal(Royal London Hospital), Erika Lam(Royal London Hospital), Oliver Spooner(Royal London Hospital), Lukas Meyer(Universität Hamburg), Jens Fiehler(Universität Hamburg), Panagiotis Papanagiotou(National and Kapodistrian University of Athens), Andreas Kastrup(Klinikum Bremen-Mitte), Maria Eleni Alexandrou(Klinikum Bremen-Mitte), Seraphine Zubel(University Hospital Magdeburg), Qingyu Wu(University Hospital Magdeburg), Anastasios Mpotsaris(University Hospital Magdeburg), Volker Maus(Universitätsklinikum Knappschaftskrankenhaus Bochum), Tommy Andersson(Karolinska University Hospital), Vamsi Gontu(Karolinska University Hospital), Fabian Arnberg(AZ Groeninge), Tsong‐Hai Lee(Chang Gung University), Bernard P.L. Chan(National University Health System), Hock Luen Teoh(National University Health System), Raymond C.S. Seet(National University of Singapore), Vijay K. Sharma(National University of Singapore), Leonard L.L. Yeo(National University of Singapore)
Cerebrovascular Diseases
January 1, 2022
10.1159/000524048
Cited by 12Open Access
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Abstract

INTRODUCTION: 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. METHODS: 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). RESULTS: 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; p = 0.001) and had higher rates of atrial fibrillation (38.9% vs. 24.2%; p = 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; p = 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; p = 0.611), favourable discharge mRS scores (mean ± SD 39 ± 31.6 vs. 43 ± 25.9; OR = 1.38; 95% CI = 0.69-2.78; p = 0.368) and in-hospital mortality (mean ± SD 30 ± 25.9 vs. 47 ± 22.8; OR = 1.15; 95% CI = 0.55-2.43; p = 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; p = 0.385) and SAH (mean ± SD 4 ± 3.4 vs. 5 ± 2.4; OR = 0.29; 95% CI = 0.03-3.09; p = 0.303) comparably low in both groups. CONCLUSION: Females achieved comparable functional outcomes compared with males after undergoing MT for BAO acute ischemic stroke.

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