Clinical neurology and neurosurgery · 2026
Sex differences in periprocedural complications of endovascular treatment for intracranial aneurysms: An analysis based on JR-NET4.
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Baba Daichi, Uchida Kazutaka, Shindo Koichiro, Shirakawa Manabu, Sakakibara Fumihiro, Fujiwara Satoru, Iihara Koji, Imamura Hirotoshi, Ishii Akira, Matsumaru Yuji, Sakai Chiaki, Satow Tetsu, Sakai Nobuyuki, Yoshimura Shinichi, JR-NET4 Study Group
Аннотация
BACKGROUND: Sex differences are well documented in cerebrovascular diseases; however, findings regarding sex-specific differences in periprocedural complications after endovascular treatment (EVT) for intracranial aneurysms remain inconsistent. We investigated sex differences in periprocedural complications and outcomes after EVT.
METHODS: We analyzed data from the nationwide Japanese Registry of Neuroendovascular Therapy 4, including patients treated between January 2015 and December 2019. Analyses were stratified by rupture status. The primary outcome was ischemic complications with neurological worsening (≥1-point deterioration in modified Rankin Scale [mRS]). Secondary outcomes included hemorrhagic complications, functional independence (mRS 0-2 at 30 days), and all-cause mortality. Crude and adjusted odds ratios (ORs) were estimated using logistic regression.
RESULTS: A total of 22,192 patients were included: 7989 with ruptured aneurysms (69% women) and 14,203 with unruptured aneurysms (74% women). The incidence of ischemic complications did not differ between women and men in ruptured (3.5% vs. 4.1%; adjusted OR 0.82, 95% CI 0.63-1.05) and unruptured aneurysms (1.6% vs. 1.5%; adjusted OR 0.98, 95% CI 0.72-1.34). In contrast, hemorrhagic complications were more frequent in women in both ruptured (1.8% vs. 1.1%; adjusted OR 1.57, 95% CI 1.02-2.41) and unruptured aneurysms (0.9% vs. 0.4%; adjusted OR 2.03, 95% CI 1.18-3.48). In ruptured aneurysms, functional independence at 30 days was more frequent in women (adjusted OR 1.21, 95% CI 1.07-1.36). No sex differences were observed in mortality.
CONCLUSIONS: In this nationwide cohort, ischemic complications were comparable between women and men regardless of rupture status, whereas hemorrhagic complications were more frequent in women.
METHODS: We analyzed data from the nationwide Japanese Registry of Neuroendovascular Therapy 4, including patients treated between January 2015 and December 2019. Analyses were stratified by rupture status. The primary outcome was ischemic complications with neurological worsening (≥1-point deterioration in modified Rankin Scale [mRS]). Secondary outcomes included hemorrhagic complications, functional independence (mRS 0-2 at 30 days), and all-cause mortality. Crude and adjusted odds ratios (ORs) were estimated using logistic regression.
RESULTS: A total of 22,192 patients were included: 7989 with ruptured aneurysms (69% women) and 14,203 with unruptured aneurysms (74% women). The incidence of ischemic complications did not differ between women and men in ruptured (3.5% vs. 4.1%; adjusted OR 0.82, 95% CI 0.63-1.05) and unruptured aneurysms (1.6% vs. 1.5%; adjusted OR 0.98, 95% CI 0.72-1.34). In contrast, hemorrhagic complications were more frequent in women in both ruptured (1.8% vs. 1.1%; adjusted OR 1.57, 95% CI 1.02-2.41) and unruptured aneurysms (0.9% vs. 0.4%; adjusted OR 2.03, 95% CI 1.18-3.48). In ruptured aneurysms, functional independence at 30 days was more frequent in women (adjusted OR 1.21, 95% CI 1.07-1.36). No sex differences were observed in mortality.
CONCLUSIONS: In this nationwide cohort, ischemic complications were comparable between women and men regardless of rupture status, whereas hemorrhagic complications were more frequent in women.