AUTHOR=Lagebrant Christian , Ramgren Birgitta , Hassani Espili Ashkan , Marañon Antonio , Kremer Christine 

TITLE=Sex Differences in Collateral Circulation and Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.878759

DOI=10.3389/fneur.2022.878759

ISSN=1664-2295

ABSTRACT=Background: Collateral circulation is known to lead to smaller infarct volume and better functional outcome after mechanical thrombectomy (MT), but studies examining sex differences in collateral circulation are scarce. The aim of this study was to investigate if collateral circulation has different impact on outcome in women and men.
Methods: Single centre retrospective study of 487 patients (230 men, 257 women) treated with MT for acute ischemic stroke in the anterior cerebral circulation. Collateral circulation was assessed on computed tomography angiography images. Outcome was evaluated at 90 days according to modified Rankin Scale (mRS).
Results: Women were older, median age 76 y. (IQR 68-83) vs. 71 y. (IQR 63-78). Stroke severity and time to recanalization were comparable. More women had moderate or good collaterals in 58.4 % versus 47.0 % for men (p = 0.01). Among patients with moderate and good collaterals significantly more men (61%) were functional independent (mRS 0-2)  than women  (41,5%) (p = < 0.01). This difference remained significant after correcting for age by linear weighting, 60.4% vs 46,8% (p = 0.03).
Conclusion: Women had better collateral flow but showed worse functional outcomes, while  good collateral flow led to better outcomes in men, even after correcting for age.  Further studies on peri- and post-interventional care, factors affecting recovery after hospital discharge as well as basic research on the neurovascular unit are needed to find modifiable targets to improve clinical outcome for women.