性别对急性缺血性卒中患者机械取栓术预后的影响OA北大核心CSTPCD

Objective To investigate the effect of sex on the prognosis of mechanical thrombectomy in acute ischemic stroke with large vessel occlusion(AIS-LVO)patients.Methods Data of AIS-LVO patients due to anterior circulation vessel occlusion and receiving mechanical thrombectomy was reviewed and analyzed in Department of Neurosurgery of Xuanwu Hospital,Capital Medical University from January 2019 to December 2021.The modified Rankin scale(mRS)score 0-2 was classified as good prognosis,and mRS score 3-6 was classified as poor prognosis 90 days after mechanical thrombectomy.Baseline data(age,sex)and clinical data of patients were collected.Clinical data included vascular disease risk factors(hypertension,diabetes,hyperlipidemia,coronary atherosclerotic heart disease[CHD],atrial fibrillation,smoking history,drinking history,stroke history),antiplatelet and anticoagulation history,baseline National Institutes of Health stroke scale(NIHSS)score,cerebral infarction classification,intravenous thrombolysis,anesthesia type,onset-to-door time,puncture-to-recanalization time(PTR),onset-to-recanalization time,baseline Alberta stroke program early CT score(ASPECTS),occlusive site,collateral circulation status,and immediate postoperative recanalization status.The patients were grouped by sex and prognosis(male and female groups,poor and good prognosis groups),and the differences in baseline and clinical data between the two groups were compared.Univariate Logistic regression analysis was used to analyze the difference of sex between different prognostic groups,and multivariate Logistic regression analysis was used to evaluate whether sex had an effect on the prognosis of patients undergoing mechanical thrombectomy.Results All 347 AIS-LVO patients were enrolled,including 126 females and 221 males,178 poor and 169 good prognosis.(1)The age,atrial fibrillation rate and baseline NIHSS score of the female group were higher than those of the male group(70.5[59.0,80.0]years old vs.64.0[56.0,71.0]years old,Z = 19.720;41.3%[52/126]vs.21.7%[48/221],χ2 = 14.950;16[13,19]scores vs.14[11,18]scores,Z =9.670),the proportion of smoking and drinking was lower than those of the male group(5.6%[7/126]vs.54.8%[121/221],χ2 =83.420;3.2%[4/126]vs.49.8%[110/221],χ2 =78.990],and the differences were all statistically significant(all P＜0.01).In the female and male groups,the cerebral infarction classification distribution from high to low was cardiogenic stroke(79.4%[100/126],52.9%[117/221]),large-artery atherosclerosis(19.0%[24/126],44.3%[98/221]),and other types(1.6%[2/126],2.7%[6/221]).There was significant difference between the two groups(χ2 =24.010,P＜0.01).There were no significant differences in other baseline and clinical data between different sex groups(all P＞0.05).(2)Univariate analysis showed that the proportion of female,age,CHD proportion,stroke history,NIHSS score and PTR in the poor prognosis group were higher than those in the good prognosis group(41.6%[74/178]vs.30.8%[52/169],70[61,77]years old vs.64[54,70]years old,31.5%[56/178]vs.16.0%[27/169],23.0%[41/178]vs.13.6%[23/169],17[13,20]min vs.13[11,17]min,39[29,69]min vs.36[25,50]min).However,ASPECTS,good collateral ratio and successful recanalization ratio were lower in the poor prognosis group than those in the good prognosis group(8[7,9]scores vs.9[8,10]scores,15.7%[28/178]vs.55.0%[93/169],86.0%[153/178]vs.98.2%[166/169]).There was statistical significance among all groups(all P＜0.05).Multivariate Logistic regression analysis showed that higher age(OR,1.025,95%CI 1.003-1.048),CHD(OR,2.467,95%CI 1.295-4.699),higher NIHSS score(OR,1.134,95%CI 1.073-1.198)and longer PTR(OR,1.011,95%CI 1.001-1.021)were risk factors for poor prognosis(all P＜0.05),and higher ASPECTS(OR,0.722,95%CI 0.581-0.897),good collateral(OR,0.171,95%CI 0.096-0.303),successful recanalization(OR,0.068,95%CI 0.015-0.313)were protective factors for good prognosis(all P＜0.05),while sex was not an influencing factor for the prognosis of patients with anterior circulation AIS-LVO receiving mechanical thrombectomy(P＞0.05).Conclusions The proportion of females in patients with good prognosis of anterior circulation AIS-LVO receiving thrombectomy was lower than that in patients with poor prognosis,but sex was not an influential factor in the prognosis of anterior circulation AIS-LVO patients receiving mechanical thrombectomy.The results of this study need to be further verified with multi-center and large sample data.