Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-27T19:40:43.015Z Has data issue: false hasContentIssue false
  • English
  • Français

No Sex Differences in Mechanical Thrombectomy Time Metrics and Outcomes in Saskatchewan

Published online by Cambridge University Press:  05 October 2023

Johanna M. Ospel Open the ORCID record for Johanna M. Ospel [Opens in a new window] ,
Nima Kashani ,
Nishita Singh ,
Amy Zhou ,
Petra Cimflova ,
Manon Kappelhof ,
Eva Liu Open the ORCID record for Eva Liu [Opens in a new window] ,
Nicole Pendleton ,
Kristen Marciniuk Open the ORCID record for Kristen Marciniuk [Opens in a new window]  and
Patrick Toyota Open the ORCID record for Patrick Toyota [Opens in a new window]
...Show all authors
Johanna M. Ospel*
Affiliation:
Department of Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
Nima Kashani
Affiliation:
Department of Radiology, University of Saskatchewan, Saskatoon, SK, Canada Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Nishita Singh
Affiliation:
Department of Neurology, University of Manitoba, Winnipeg, MB, Canada
Amy Zhou
Affiliation:
College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
Petra Cimflova
Affiliation:
Department of Diagnostic Imaging, University of Calgary Cumming School of Medicine, Calgary, AB, Canada Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
Manon Kappelhof
Affiliation:
Department of Radiology, University of Amsterdam, Amsterdam, Netherlands
Eva Liu
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Nicole Pendleton
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Kristen Marciniuk
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Patrick Toyota
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Braedon Newton
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Amit Persad
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Jessalyn Holodinsky
Affiliation:
Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
Lotus Yang
Affiliation:
Department of Radiology, University of Saskatchewan, Saskatoon, SK, Canada
Michaela Perlau
Affiliation:
Department of Radiology, University of Saskatchewan, Saskatoon, SK, Canada
Sarah Abdalrahman
Affiliation:
Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
Aaron Gardner
Affiliation:
Department of Clinical Nursing, University of Saskatchewan, Saskatoon, SK, Canada
Regan Cooley
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
Sanchea Wasyliw
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
Brett R. Graham
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
Aravind Ganesh
Affiliation:
Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
Gary Hunter
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
Ruth Whelan
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
Uzair Ahmed
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Michael E. Kelly
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
Lissa Peeling
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Saskatoon, SK, Canada
*
Corresponding author: J. M. Ospel; Email: johanna.ospel@ucalgary.ca
Get access Rights & Permissions [Opens in a new window]

Abstract:

Background and Purpose:

Numerous studies have shown longer pre-hospital and in-hospital workflow times and poorer outcomes in women after acute ischemic stroke (AIS) in general and after endovascular treatment (EVT) in particular. We investigated sex differences in acute stroke care of EVT patients over 5 years in a comprehensive Canadian provincial registry.

Methods:

Clinical data of all AIS patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan were captured in the Canadian OPTIMISE registry and supplemented with patient data from administrative data sources. Patient baseline characteristics, transport time metrics, and technical EVT outcomes between female and male EVT patients were compared.

Results:

Three-hundred-three patients underwent EVT between 2017 and 2022: 144 (47.5%) women and 159 (52.5%) men. Women were significantly older (median age 77.5 [interquartile range: 66–85] vs.71 [59–78], p < 0.001), while men had more intracranial internal carotid artery occlusions (48/159 [30.2%] vs. 26/142 [18.3%], p = 0.03). Last-known-well to comprehensive stroke center (CSC)-arrival time (median 232 min [interquartile range 90–432] in women vs. 230 min [90–352] in men), CSC-arrival-to-reperfusion time (median 108 min [88–149] in women vs. 102 min [77–141] in men), reperfusion status (successful reperfusion 106/142 [74.7%] in women vs. 117/158 [74.1%] in men) as well as modified Rankin score at 90 days did not differ significantly. This held true after adjusting for baseline variables in multivariable analyses.

Conclusion:

While women undergoing EVT in the province of Saskatchewan were on average older than men, they were treated just as fast and achieved similar technical and clinical outcomes compared to men.

Résumé:

Résumé:

La thrombectomie mécanique : pas de différence entre les sexes en ce qui concerne les indicateurs de temps et les résultats obtenus en Saskatchewan.

Contexte et but :

Dans de nombreuses études, on fait état de flux de travaux prolongés en phase préhospitalière et hospitalière et de résultats moins favorables chez les femmes que chez les hommes après un accident vasculaire cérébral (AVC) ischémique aigu en général, et notamment après un traitement endovasculaire (TEV). L’étude, fondée sur un registre provincial exhaustif au Canada, avait donc pour but d’examiner les différences de soins donnés aux hommes et aux femmes traités par TEV après un accident vasculaire cérébral aigu, sur une période de 5 ans.

Méthode :

Des données cliniques recueillies sur tous les patients soumis à un TEV après un AVC ischémique aigu, entre janvier 2017 et décembre 2022, en Saskatchewan, ont été inscrites dans le registre OPTIMISE au Canada, puis complétées par d’autres données sur des patients, provenant de sources administratives. Il y a eu ensuite comparaison des données en ce qui concerne les caractéristiques de base, les mesures du temps de transport et les résultats techniques du TEV, entre les hommes et les femmes.

Résultats :

Dans l’ensemble, 303 patients ont subi un TEV entre 2017 et 2022, soit 144 femmes (47,5 %) et 159 hommes (52,5 %). Les femmes étaient significativement plus âgées que les hommes (âge médian : 77,5 ans [intervalle interquartile {II} : 66-85] contre [c.] 71 [59-78]; p < 0,001), tandis que les hommes souffraient davantage d’occlusions intracrâniennes de la carotide interne (48/159 [30,2 %] c. 26/142 [18,3 %]; p = 0,03). Les données relatives au temps écoulé entre le dernier moment où la personne avait été vue en bonne santé et l’arrivée au centre de soins intégrés des AVC (temps médian : 232 min [II : 90-432] chez les femmes c. 230 min [90-352] chez les hommes), au temps écoulé entre l’arrivée au centre de soins intégrés et la reperfusion (temps médian : 108 min [88-149] chez les femmes c. 102 min [77-141] chez les hommes), aux résultats de la reperfusion (reperfusion réussie : 106/142 [74,7 %] chez les femmes c. 117/158 [74,1 %] chez les hommes) et au score de Rankin modifié au bout de 90 jours ne présentaient pas de différence significative, et ce, malgré le rajustement des variables de base dans les analyses plurifactorielles.

Conclusion :

Si les femmes soumises à un TEV en Saskatchewan étaient en moyenne plus âgées que les hommes, le temps écoulé avant le traitement était aussi court que celui enregistré chez les hommes, et les résultats cliniques et techniques obtenus dans les deux groupes étaient comparables.

Keywords

Thrombectomyischemic strokesex
Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 6
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ospel, J, Singh, N, Ganesh, A, Goyal, M. Sex and gender differences in stroke and their practical implications in acute care. J Stroke. 2023;25:16–25.CrossRefGoogle ScholarPubMed
Ospel, JM, Schaafsma, JD, Leslie-Mazwi, TM, et al. Toward a better understanding of sex- and gender-related differences in endovascular stroke treatment: a scientific statement from the American heart association/American stroke association. Stroke. 2022;53:e396–e406.CrossRefGoogle Scholar
Appelros, P, Stegmayr, B, Terent, A. Sex differences in stroke epidemiology: a systematic review. Stroke. 2009;40:1082–90.CrossRefGoogle ScholarPubMed
Willers, C, Lekander, I, Ekstrand, E, et al. Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study. Biol Sex Differ. 2018;9:11.CrossRefGoogle ScholarPubMed
Madsen, TE, DeCroce-Movson, E, Hemendinger, M, et al. Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg. 2019;11:221–5.CrossRefGoogle ScholarPubMed
Mainz, J, Andersen, G, Valentin, JB, Gude, MF, Johnsen, SP. Disentangling sex differences in use of reperfusion therapy in patients with acute ischemic stroke. Stroke. 2020;51:2332–8.CrossRefGoogle ScholarPubMed
Uchida, K, Yoshimura, S, Sakai, N, Yamagami, H, Morimoto, T. Sex differences in management and outcomes of acute ischemic stroke with large vessel occlusion. Stroke. 2019;50:1915–8.CrossRefGoogle ScholarPubMed
Caso, V, Paciaroni, M, Agnelli, G, et al. Gender differences in patients with acute ischemic stroke. Womens Health (Lond). 2010;6:51–7.CrossRefGoogle ScholarPubMed
Hemmen, T. Patient delay in acute stroke response. Eur J Neurol. 2008;15:315–6.CrossRefGoogle ScholarPubMed
Naveed, H, Almasri, M, Kazani, B, et al. Women and stroke: disparities in clinical presentation, severity, and short- and long-term outcomes. Front Neurol. 2023;14:1147858.CrossRefGoogle ScholarPubMed
Deb-Chatterji, M, Schlemm, E, Flottmann, F, et al. Sex differences in outcome after thrombectomy for acute ischemic stroke are explained by confounding factors. Clin Neuroradiol. 2021;31:1101–9.CrossRefGoogle ScholarPubMed
Dmytriw, AA, Ku, JC, Yang, VXD, et al. Do outcomes between women and men differ after endovascular thrombectomy? A meta-analysis. AJNR Am J Neuroradiol. 2021;42:910–915.CrossRefGoogle ScholarPubMed
Saskatchewan Go. Record Population Growth as Saskatchewan Surges Past 1.2 Million People. 2023. [cited; Available from: https://www.saskatchewan.ca/government/news-and-media/2022/december/21/record-population-growth-as-saskatchewan-surges-past-12-million-people. Accessed December 21, 2022.Google Scholar
Sajobi, T, Singh, N, Almekhlafi, MA, et al. AcT trial: protocol for a pragmatic registry-linked randomized clinical trial. Stroke Vasc Interv Neurol. 2022;2:e000447.Google Scholar
Bala, F, Casetta, I, Nannoni, S, et al. Sex-related differences in outcomes after endovascular treatment of patients with late-window stroke. Stroke. 2022;53:311–8.CrossRefGoogle ScholarPubMed
Ouyang, M, Shajahan, S, Liu, X, et al. Sex differences in the utilization and outcomes of endovascular treatment after acute ischemic stroke: a systematic review and meta-analysis. Front Glob Womens Health. 2022;3:1032592.CrossRefGoogle ScholarPubMed
Sheth, SA, Lee, S, Warach, SJ, et al. Sex differences in outcome after endovascular stroke therapy for acute ischemic stroke. Stroke. 2019;50:2420–7.CrossRefGoogle ScholarPubMed
Foerch, C, Misselwitz, B, Humpich, M, et al. Sex disparity in the access of elderly patients to acute stroke care. Stroke. 2007;38:2123–6.CrossRefGoogle ScholarPubMed
Perez-Sanchez, S, Barragan-Prieto, A, Ortega-Quintanilla, J, et al. Sex differences by hospital-level in performance and outcomes of endovascular treatment for acute ischemic stroke. J Stroke. 2020;22:258–61.CrossRefGoogle ScholarPubMed
Smith, EE, Saver, JL, Cox, M, et al. Increase in endovascular therapy in get with the guidelines-stroke after the publication of pivotal trials. Circulation. 2017;136:2303–10.CrossRefGoogle ScholarPubMed
Holloway, RG, Arnold, RM, Creutzfeldt, CJ, et al. Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American heart association/American stroke association. Stroke. 2014;45:1887–916.CrossRefGoogle ScholarPubMed
Demel, SL, Reeves, M, Xu, H, et al. Sex differences in endovascular therapy for ischemic stroke: results from the get with the guidelines-stroke registry. Stroke. 2022;53:3099–106.CrossRefGoogle ScholarPubMed
Dmytriw, AA, Ku, JC, Yang, VXD, et al. Do outcomes between women and men differ after endovascular thrombectomy? A meta-analysis. AJNR Am J Neuroradiol. 2021;42:910–5.CrossRefGoogle ScholarPubMed
Mandel, H, Semyonov, M. Gender pay gap and employment sector: sources of earnings disparities in the United States, 1970-2010. Demography. 2014;51:1597–618.CrossRefGoogle ScholarPubMed
Moleiro, C, Pinto, N. Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Front Psychol. 2015;6:1511.CrossRefGoogle ScholarPubMed
Chan, PS. Invisible gender in medical research. Circ Cardiovasc Qual Outcomes. 2019;12:e005694.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Ospel et al. supplementary material

Ospel et al. supplementary material

Download Ospel et al. supplementary material(PDF)
PDF 532.4 KB