Abstract 2187: Are Procedural Characteristics Associated with Early Outcomes in Either Women or Men Revascularized in the Merci Registry?
Introduction: Data suggest a higher periprocedural risk for endovascular treatment than surgery for carotid artery stenosis in women but not in men. The objective of this analysis was to determine if a similar risk profile applies to acute ischemic stroke (AIS).
Hypothesis: Sex differences in procedural characteristics could be associated with early outcomes after successful endovascular treatment for AIS.
Methods: The study investigated whether procedural characteristics in recanalized patients (TICA 2a, 2b or 3) in the Merci Registry, a prospective database of AIS patients treated with the Merci Retriever, were associated with favorable discharge outcome (mRS 0-2) in either women or in men. Procedural characteristics included the length of the procedure; use of intra-arterial lytics and other devices; intubation; or systolic blood pressure. Clinical variables included age, baseline National Institutes of Health Stroke Scale (NIHSS), time from symptom onset and emergency department (ED) arrival to arterial puncture, intravenous tPA use, co-morbidities and risk factors. The procedural and clinical variables were assessed with univariate and then multivariate analysis for associations with the early outcomes separately in women and in men.
Results: Of 872 Merci Registry patients with complete follow-up data, similar numbers of women (327/418 (78%)) and men (369/454 (81%)) had successful revascularization. Revascularized women compared to revascularized men were older, had more hypertension and atrial fibrillation and revascularized men had more history of coronary artery disease than women. Clot location was more often vertebrobasilar in men. While the procedure duration and number of attempts to remove the clot was equivalent in the two groups, angioplasty and stenting proximal to the occlusion occurred more often in men. The number of women and men that had a discharge mRS 0-2 was similar (20.3% and 21.5% respectively). In multivariate analysis, baseline NIHSS (p<0.0001) was negatively associated with discharge outcome in both women and in men. Additionally, while procedure length (p=0.0050) and diabetes (p=0.0228) were negatively associated with outcome in men, in women intubation (p<0.0001), age (p=0.0016) and congestive heart failure (p=0.0124) were negatively associated with discharge outcome.
Conclusions: Procedure length and diabetes in successfully revascularized patients in the Merci Registry were negatively associated with discharge outcome in men but not in women in multivariate analysis, while intubation was the only procedural characteristic associated (negatively) with early outcome in women and baseline NIHSS was negatively associated in both groups.
- © 2012 by American Heart Association, Inc.