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Publications

Journal Article Ahead of print

PubMed: 42891905 DOI: 10.1007/s11547-026-02301-1

Sex-related differences in baseline neuroimaging, treatment workflow, and outcomes of ischemic stroke following thrombectomy: data from an inverse propensity score weighted analysis.

Radiol Med

Authors: Giorgio Busto, Ilaria Casetta, Umberto Pensato, Vanessa Palumbo, Cristina Sarti, Giovanni Noto, Jacopo Andreis, Francesca Di Pasquale, Andrea Ginestroni, Andrea Morotti, Alessandro Padovani, Vittorio Miele, Enrico Fainardi

Affiliations

  • Department of Radiology, Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
  • Dipartimento Di Scienze Biomediche, Struttura Organizzativa Dipartimentale Di Neuroradiologia, Sperimentali E Cliniche "Mario Serio", Università Degli Studi Di Firenze, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy.
  • IRCCS San Camillo Hospital, Venice, Italy.
  • Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20072, Milan, Italy.
  • Department of Neurology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
  • Stroke Unit Careggi University Hospital, Florence, Italy.
  • Department of Radiology, Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
  • Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy.
  • Department of Radiology, Careggi University Hospital, Florence, Italy.
  • Department of Experimental and Clinical Biomedical Sciences, Neuroradiology Unit, University of Florence, Florence, Italy.

Abstract

PURPOSE

We investigated sex differences in baseline neuroimaging, treatment workflow, and outcomes among ischemic stroke patients undergoing endovascular treatment (EVT) within 24 h from last known well.

METHODS

Consecutive stroke patients who underwent a multimodal CT study protocol, EVT, and non-contrast CT follow-up imaging at 24 h were analyzed. We compared clinical and safety outcomes between males and females who received EVT in both the original population and a Propensity Score-balanced set. We performed univariable analyses to identify baseline neuroimaging, treatment workflow, and outcomes that differed between sexes. We used multivariable logistic regression to assess whether sex was associated with outcomes after adjusting for covariates.

RESULTS

Among 615 patients included in the analysis, 318 (51.7%) were female. Compared to females, males were younger (p <0.001), more independent before stroke (p <0.001), had a lower prevalence of atrial fibrillation (p < 0.001), and had lower internal carotid artery occlusion (p < 0.013). Compared to male, females had lower total hypoperfused tissue (109.3 mL [IQR=66.4-151.3] vs. 86.3 mL [IQR=43.4-132.3]; p<0.001), lower penumbra volumes (78.1 mL [IQR=43.9-114.8] vs. 47.7 mL [IQR=24.6-76.6], p<0.001), lower mismatch ratio (2.63 [IQR=1.86-4.49] vs. 3.67 [IQR=2.27-6.53]; p<0.001), and lower hypoperfusion intensity ratio (0.30 [IQR=0.18-0.50] vs. 0.38 [IQR=0.22-0.50]; p<0.001). In multivariable logistic regression analysis, sex was not an independent predictor of good clinical outcomes after EVT, although females died less than males and had a lower incidence of hemorrhagic transformation.

CONCLUSION

In our cohort of acute ischemic stroke treated with EVT, females showed an overall better perfusion profile at baseline compared to males, suggesting they may be slow progressors; however, this did not translate into better clinical outcomes. More data are needed to clarify the relationship between neuroimaging and sex, as well as the influence of other clinical factors on outcomes among patients undergoing EVT.

MeSH

Ischemic Stroke, Stroke, Neuroimaging, Workflow, Propensity Score, Radiology, Sex, Therapeutics, Thrombectomy