La Radiologia medica · 2026
Sex-related differences in baseline neuroimaging, treatment workflow, and outcomes of ischemic stroke following thrombectomy: data from an inverse propensity score weighted analysis.
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Busto Giorgio, Casetta Ilaria, Pensato Umberto, Palumbo Vanessa, Sarti Cristina, Noto Giovanni, Andreis Jacopo, Di Pasquale Francesca, Ginestroni Andrea, Morotti Andrea, Padovani Alessandro, Miele Vittorio, Fainardi Enrico
Аннотация
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.
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.