J Neurocrit Care.  2022 Dec;15(2):104-112. 10.18700/jnc.220054.

Failed recanalization mediates the association of women with poor outcomes after thrombectomy: a single-center experience

• Lee SJ
• Lee TK
• Moon JE

• KMID: 2538767
• DOI: http://doi.org/10.18700/jnc.220054

Abstract

Background
Whether thrombectomy benefits differ according to sex remains debatable. We aimed to investigate whether there was a difference in stroke outcomes between men and women treated with thrombectomy.
Methods
We studied 173 patients with anterior circulation strokes. Failed recanalization was defined as thrombolysis in cerebral infarction grade 0-2a. Scores >2 on the modified Rankin Scale at 3 months were regarded as poor outcomes. To prove that failed recanalization mediated the association between sex differences and functional outcome, the four steps of the reasoning process adapted from Baron and Kenny’s causal-steps approach were tested. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.
Results
This study included 76 women and 97 men. Women were older and presented with atrial fibrillation more frequently than men. Female sex was independently associated with failed recanalization (aOR, 2.729; 95% CI, 1.334–5.582), which was an independent predictor of poor outcomes (aOR, 4.630; 95% CI, 1.882–11.389). Women were associated with poor outcomes in the analysis adjusted for confounders, except for failed recanalization (aOR, 2.285; 95% CI, 1.064–4.906). However, the association became insignificant in the additional analysis adjusted for failed recanalization (aOR, 1.670; 95% CI, 0.738–3.784). The indirect effect between female sex and poor outcomes via failed recanalization was statistically significant (aOR, 1.038; 95% CI, 1.010–1.127).
Conclusion
Our study showed that failed recanalization mediated the association between women and poor outcomes after thrombectomy. Nonetheless, this might be explained by chance given our limited study population.

Keyword

Sex; Stroke; Outcome; Thrombectomy

Figure

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  Fig. 1. Mediation analysis: failed recanalization as a mediator for the association of women with poor outcomes. mRS, modified Rankin Scale; A, the effect of women on failed recanalization; B, the effect of failed recanalization on poor outcomes additionally adjusted for women; C, total effect of women on poor outcomes; C’, direct effect of women on poor outcomes additionally adjusted for failed recanalization; A×B, indirect effect between women and poor functional outcomes via failed recanalization. All analyses were adjusted for age and variables with P<0.1 in the univariate analysis for each dependent variable. a)Adjusted for age, systolic blood pressure at admission, National Institutes of Health Stroke Scale score at admission, CT (computed tomography) angiography source image Alberta Stroke Program Early CT Score (CTA-SI ASPECTS), and poor collaterals; b)Adjusted for age, premorbid independence, previous anticoagulant use, National Institutes of Health Stroke Scale score at admission, M2 occlusion (vs. internal carotid artery or M1 occlusion), CTA-SI ASPECTS, and poor collaterals.

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