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Sex Differences in Endovascular Treatment for Stroke: A Population-based Analysis

Published online by Cambridge University Press:  21 October 2020

Charlotte Zerna
Affiliation:
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Edwin Rogers
Affiliation:
Clinical Analytics, Alberta Health Services, Edmonton, Alberta, Canada
Doreen M. Rabi
Affiliation:
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Andrew M. Demchuk
Affiliation:
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Noreen Kamal
Affiliation:
Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
Balraj Mann
Affiliation:
Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
Tom Jeerakathil
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Brian Buck
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Ashfaq Shuaib
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Jeremy Rempel
Affiliation:
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
Bijoy K. Menon
Affiliation:
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Mayank Goyal
Affiliation:
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Michael D. Hill
Affiliation:
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Corresponding

Abstract:

Background:

Acute ischemic stroke may affect women and men differently. We aimed to evaluate sex differences in outcomes of endovascular treatment (EVT) for ischemic stroke due to large vessel occlusion in a population-based study in Alberta, Canada.

Methods and Results:

Over a 3-year period (April 2015–March 2018), 576 patients fit the inclusion criteria of our study and constituted the EVT group of our analysis. The medical treatment group of the ESCAPE trial had 150 patients. Thus, our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database methodology. The primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at their premorbid living situation without an increase in the level of care within 90 days of the index stroke event. In adjusted analysis, EVT was associated with an increase of 90-day home-time by an average of 6.08 (95% CI −2.74–14.89, p-value 0.177) days in women compared to an average of 11.20 (95% CI 1.94–20.46, p-value 0.018) days in men. Further analysis revealed that the association between EVT and 90-day home-time in women was confounded by age and onset-to-treatment time.

Conclusions:

We found a nonsignificant nominal reduction of 90-day home-time gain for women compared to men in this province-wide population-based study of EVT for large vessel occlusion, which was only partially explained by confounding.

Résumé :

RÉSUMÉ :

Différences de sexe dans le traitement endovasculaire de l’AVC : analyse fondée sur la population.

Contexte :

Les accidents vasculaires cérébraux (AVC) ischémiques peuvent affecter différemment les hommes et les femmes. L’étude visait à évaluer les différences de sexe quant aux résultats du traitement endovasculaire (TEV) des AVC ischémiques, attribuables à l’occlusion de gros vaisseaux sanguins, dans une étude fondée sur la population en Alberta, au Canada.

Méthode et résultats :

Sur une période de trois ans (avril 2015 – mars 2018), 576 patients satisfaisaient aux critères de sélection de l’étude et ils ont formé le groupe de TEV. Le groupe de traitement médical dans l’essai ESCAPE comptait 150 patients, ce qui a porté à 726 le nombre total de sujets dans l’échantillon. Les résultats obtenus dans la pratique courante ont été relevés à l’aide de données administratives et d’une base de données liée. Le principal critère d’évaluation était le temps passé à domicile, défini comme le nombre de jours écoulés avant que le patient retrouve sa situation de vie antérieure à l’événement, et ce, sans augmentation de soins dans les 90 jours suivant l’AVC de référence. Dans l’analyse rajustée, le TEV a été associé, durant cette période de 90 jours, à une augmentation moyenne de 6,08 jours (IC à 95 % : −2,74 – 14,89; p : 0,177) chez les femmes contre 11,20 jours (IC à 95 % : 1,94 – 20,46; p : 0,018) chez les hommes. Selon une analyse approfondie, la relation entre le TEV et cette période de 90 jours chez les femmes a été influencée par l’âge et le temps écoulé entre la survenue de l’événement et l’amorce du traitement.

Conclusion :

Il ressort de cette étude sur le TEV de l’occlusion de gros vaisseaux, fondée sur la population et menée à la grandeur de la province, que les femmes ont connu une réduction nominale non significative du temps gagné à domicile, durant cette période de 90 jours, par rapport aux hommes, écart qui ne s’explique en partie que par des facteurs parasites.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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