Biological Sex and Outcomes in Patients with Extracranial Cervical Arterial Dissections
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CeAD | cervical arterial dissection |
ICH | intracerebral hemorrhage |
NIHSS | National Institutes of Health stroke Scale |
mRS | modified Rankin Scale |
tCeAD | traumatic CeAD |
sCeAD | spontaneous CeAD |
sICH | symptomatic ICH |
tPA | tissue Plasminogen Activator |
References
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Variable/Group | Unmatched Patients, No, (%) | p | After Propensity Score Matching, No. (%) | p | ||
---|---|---|---|---|---|---|
Males | Females | Males | Females | |||
(n = 79) | (n = 56) | (n = 56) | (n = 56) | |||
Age (Median; Q1, Q3) | 45 (36, 51.5) | 41 (36.5, 48.2) | 0.439 | 44 (35, 52.2) | 41 (36.5, 48.2) | 0.852 |
Hypertension (%) | 18 (22.8) | 10 (17.9) | 0.525 | 8 (14.3) | 10 (17.9) | 0.797 |
Diabetes (%) | 5 (6.3) | 2 (3.6) | 0.699 | 3 (5.4) | 2 (3.6) | 1.000 |
Atrial fibrillation (%) | 3 (3.8) | 0 (0) | 0.266 | |||
Hyperlipidemia (%) | 15 (19) | 2 (3.6) | 0.266 | 6 (10.7) | 2 (3.6) | 0.270 |
Smoking (%) | 30 (38) | 6 (10.7) | 0.0004 | 14 (25) | 6 (10.7) | 0.082 |
Old stroke (%) | 3 (3.8) | 1 (1.8) | 0.641 | 0 (0) | 1 (1.8) | 1.000 |
Migraine (%) | 1 (1.3) | 4 (7.1) | 0.159 | 1 (1.8) | 4 (7.1) | 0.363 |
Violent cough (%) | 7 (8.9) | 6 (10.7) | 0.772 | 7 (12.5) | 6 (10.7) | 1.000 |
Spontaneous dissection (%) | 50 (63.3) | 43 (76.8) | 0.130 | 36 (64.3) | 43 (76.8) | 0.213 |
Neck injury (%) | 15 (19) | 4 (7.1) | 0.077 | 10 (17.9) | 4 (7.1) | 0.151 |
Poly-trauma (%) | 14 (17.7) | 6 (10.7) | 0.328 | 10 (17.9) | 6 (10.7) | 0.418 |
Trauma severity (%) | 0.118 | 0.154 | ||||
Non Trauma | 50 (63.3) | 46 (82.1) | 36 (64.3) | 46 (82.1) | ||
Mild | 12 (15.2) | 3 (5.4) | 9 (16.1) | 3 (5.4) | ||
Moderate | 7 (8.9) | 3 (5.4) | 4 (7.1) | 3 (5.4) | ||
severe | 10 (12.7) | 4 (7.1) | 7 (12.5) | 4 (7.1) | ||
Premorbid mRS ≤ 2 (%) | 78 (98.7) | 56 (100) | 1.000 | 56 (100) | 56 (100) | 1.000 |
Admission NIHSS (Median; Q1,Q3) | 0.0 (0.0, 5.0) | 0.0 (0.0, 2.0) | 0.070 | 0 (0.0, 3.0) | 0 (0.0, 3.0) | 0.326 |
Radiological findings (%) | ||||||
Early infarct signs on initial CT/MR | 30 (38) | 20 (35.7) | 0.857 | 19 (33.9) | 20 (35.7) | 1.000 |
Carotid only | 48 (60.8) | 28 (50) | 0.223 | 34 (60.7) | 28 (50) | 0.342 |
Vertebral only | 19 (24.1) | 18 (32.1) | 0.331 | 14 (25) | 18 (32.1) | 0.530 |
More than one vessel | 16 (20.3) | 13 (23.2) | 0.677 | 11 (19.6) | 13 (23.2) | 0.818 |
Intimal flap | 17 (21.8) | 11 (19.6) | 0.831 | 13 (23.6) | 11 (19.6) | 0.650 |
Pseudo-aneurysm | 18 (23.7) | 20 (35.7) | 0.173 | 10 (18.9) | 20 (35.7) | 0.056 |
Mural hematoma | 12 (15.2) | 14 (25) | 0.186 | 7 (12.5) | 14 (25) | 0.145 |
Long stenosis | 33 (41.8) | 29 (51.8) | 0.294 | 26 (46.4) | 29 (51.8) | 0.705 |
Double Lumen | 3 (3.8) | 6 (10.7) | 0.162 | 3 (5.4) | 6 (10.7) | 0.489 |
Vessel occlusion | 26 (32.9) | 9 (16.1) | 0.030 | 13 (23.2) | 9 (16.1) | 0.476 |
Elongated tapering | 1 (1.3) | 1 (1.8) | 1.000 | 1 (1.8) | 1 (1.8) | 1.000 |
Flame shaped | 30 (38) | 5 (8.9) | 0.0001 | 13 (23.2) | 5 (8.9) | 0.069 |
Treatments (%) | ||||||
tPA | 6 (7.6) | 2 (3.6) | 0.468 | 1 (1.8) | 2 (3.6) | 1.000 |
Stent placement | 32 (40.5) | 17 (30.4 | 0.276 | 18 (32.1) | 17 (30.4) | 1.000 |
Unmatched Patients, No, (%) | p | After Propensity Score Matching, No. (%) | p | |||
---|---|---|---|---|---|---|
Males | Females | Males | Females | |||
(n = 79) | (n = 56) | (n = 56) | (n = 56) | |||
ICH (%) | 8 (10.1) | 2 (3.6) | 0.194 | 7 (12.5) | 2 (3.6) | 0.161 |
s-ICH (%) | 4 (5.1) | 1 (1.8) | 0.402 | 4 (7.1) | 1 (1.8) | 0.363 |
Recurrent stroke (%) | 6 (7.6) | 5 (8.9) | 0.762 | 3 (5.4) | 5 (8.9) | 0.716 |
Recurrent dissection (%) | 3 (3.9) | 0 (0) | 0.273 | 2 (3.7) | 0 (0) | 0.495 |
Favorable recanalization (%) | 36 (59) | 22 (51.2) | 0.547 | 26 (61.9) | 22 (51.2) | 0.383 |
mRS on day 90 (%) | 0.251 | 0.926 | ||||
0 | 49 (62) | 45 (80.4) | 41 (73.2) | 45 (80.4) | ||
1 | 12 (15.2) | 4 (7.1) | 4 (7.1) | 4 (7.1) | ||
2 | 9 (11.4) | 4 (7.1) | 6 (10.7) | 4 (7.1) | ||
3 | 6 (7.6) | 1 (1.8) | 2 (3.6) | 1 (1.8) | ||
4 | 2 (2.5) | 1 (1.8) | 2 (3.6) | 1 (1.8) | ||
5 | 1 (1.3) | 1 (1.8) | 1 (1.8) | 1 (1.8) | ||
mRS day 90 ≤ 2 (%) | 70 (88.6) | 53 (94.6) | 0.358 | 51 (91.1) | 53 (94.6) | 0.716 |
mRS day 90 ≤ 1 (%) | 63 (79.7) | 50 (89.3) | 0.161 | 46 (82.1) | 50 (89.3) | 0.418 |
Variable/Group | Favorable (n = 123) | Unfavorable (n = 12) | p Value |
---|---|---|---|
Age (median; IQR) | 44 (37.5, 52.5) | 36 (19.8, 41.3) | 0.008 |
Biological sex (male, %) | 71 (57.7) | 9 (75) | 0.182 |
Hypertension (%) | 27 (22) | 1 (8.3) | 0.459 |
Diabetes (%) | 7 (7.5) | 0 (0) | 1.000 |
Atrial fibrillation (%) | 3 (2.4) | 0 (0) | 1.000 |
Ischemic heart disease (%) | 3 (2.4) | 0 (0) | 1.000 |
Hyperlipidemia (%) | 16 (13) | 1 (8.3) | 1.000 |
Current smoker (%) | 34 (27.6) | 2 (16.7) | 0.514 |
Prior stroke (%) | 3 (2.4) | 1 (8.3) | 0.314 |
Early signs of infarct on imaging (%) | 45 (36.6) | 5 (41.7) | 0.760 |
Involved vessels: | |||
Carotid only (%) | 72 (58.5) | 4 (33.3) | 0.128 |
Vertebral only (%) | 34 (27.6) | 3 (25) | 1.000 |
More than one vessel (%) | 23 (18.7) | 6 (50) | 0.021 |
Radiological findings: | |||
Intimal flap (%) | 28 (21) | 3 (25) | 1.000 |
Pseudo aneurysm (%) | 36 (29.8) | 2 (18.2) | 0.510 |
Mural hematoma (%) | 23 (18.7) | 3 (25) | 0.700 |
Elongated stenosis (%) | 60 (48.8) | 2 (16.7) | 0.037 |
Double lumen (%) | 9 (7.3) | 0 (0) | 1.000 |
Occlusion (%) | 29 (23.6) | 6 (50) | 0.078 |
Admission NIHSS (median, IQR) | 0 (0–3) | 14 (7, 19) | <0.001 |
tPA (%) | 8 (6.5) | 0 (0) | 1.000 |
Stent placement (%) | 41 (33.3) | 8 (66.7) | 0.029 |
sICH (%) | 3 (2.4) | 3 (25) | <0.001 |
Recurrent dissection (%) | 2 (1.6) | 1 (8.3) | 0.130 |
Favorable recanalization (%) | 54 (43.9) | 6 (50) | 0.721 |
Variable/Group | OR | 95% CI | p |
---|---|---|---|
Age (per year) | 1.12 | 1.04–1.24 | 0.008 |
Biological sex (male) | 0.53 | 0.03–5.80 | 0.614 |
Admission NIHSS | 0.73 | 0.60–0.84 | <0.001 |
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Metanis, I.; Simaan, N.; Schwartzmann, Y.; Jubeh, T.; Honig, A.; Jubran, H.; Magadle, J.; Gomori, J.M.; Cohen, J.E.; Leker, R.R. Biological Sex and Outcomes in Patients with Extracranial Cervical Arterial Dissections. J. Clin. Med. 2025, 14, 3816. https://doi.org/10.3390/jcm14113816
Metanis I, Simaan N, Schwartzmann Y, Jubeh T, Honig A, Jubran H, Magadle J, Gomori JM, Cohen JE, Leker RR. Biological Sex and Outcomes in Patients with Extracranial Cervical Arterial Dissections. Journal of Clinical Medicine. 2025; 14(11):3816. https://doi.org/10.3390/jcm14113816
Chicago/Turabian StyleMetanis, Issa, Naaem Simaan, Yoel Schwartzmann, Tamer Jubeh, Asaf Honig, Hamza Jubran, Jad Magadle, John M. Gomori, Jose E. Cohen, and Ronen R. Leker. 2025. "Biological Sex and Outcomes in Patients with Extracranial Cervical Arterial Dissections" Journal of Clinical Medicine 14, no. 11: 3816. https://doi.org/10.3390/jcm14113816
APA StyleMetanis, I., Simaan, N., Schwartzmann, Y., Jubeh, T., Honig, A., Jubran, H., Magadle, J., Gomori, J. M., Cohen, J. E., & Leker, R. R. (2025). Biological Sex and Outcomes in Patients with Extracranial Cervical Arterial Dissections. Journal of Clinical Medicine, 14(11), 3816. https://doi.org/10.3390/jcm14113816