TY - JOUR
T1 - Sex-dependent characteristics and outcomes after clipping of unruptured intracranial aneurysms
T2 - a multicenter propensity score–matched study
AU - Drexler, Richard
AU - Sauvigny, Jennifer
AU - Pantel, Tobias F.
AU - Ricklefs, Franz L.
AU - Catapano, Joshua S.
AU - Wanebo, John E.
AU - Lawton, Michael T.
AU - Sanchin, Aminaa
AU - Hecht, Nils
AU - Vajkoczy, Peter
AU - Raygor, Kunal P.
AU - Tonetti, Daniel A.
AU - Abla, Adib
AU - Naamani, Kareem El
AU - Tjoumakaris, Stavropoula I.
AU - Jabbour, Pascal
AU - Jankowitz, Brian T.
AU - Salem, Mohamed M.
AU - Burkhardt, Jan Karl
AU - Wagner, Arthur
AU - Wostrack, Maria
AU - Gempt, Jens
AU - Meyer, Bernhard
AU - Gaub, Michael
AU - Mascitelli, Justin R.
AU - Dodier, Philippe
AU - Bavinzski, Gerhard
AU - Roessler, Karl
AU - Stroh, Nico
AU - Gmeiner, Matthias
AU - Gruber, Andreas
AU - Figueiredo, Eberval G.
AU - Coelho, Antonio Carlos Samaia da Silva
AU - Bervitskiy, Anatoliy V.
AU - Anisimov, Egor D.
AU - Rzaev, Jamil A.
AU - Krenzlin, Harald
AU - Keric, Naureen
AU - Ringel, Florian
AU - Park, Dougho
AU - Kim, Mun Chul
AU - Marcati, Eleonora
AU - Cenzato, Marco
AU - Westphal, Manfred
AU - Sauvigny, Thomas
AU - Dührsen, Lasse
N1 - Publisher Copyright:
© 2024 American Association of Neurological Surgeons. All rights reserved.
PY - 2024/11
Y1 - 2024/11
N2 - OBJECTIVE Disparities in the epidemiology and growth rates of aneurysms between the sexes are known. However, little is known about sex-dependent outcomes after microsurgical clipping of unruptured intracranial aneurysms (UIAs). The aim of this study was to examine sex differences in characteristics and outcomes after microsurgical clipping of UIAs and to perform a propensity score–matched analysis using an international multicenter cohort. METHODS This retrospective cohort study involved the participation of 15 centers spanning four continents. It included adult patients who underwent clipping of UIAs between January 2016 and December 2020. Patients were stratified according to their sex and analyzed for differences in morbidities and aneurysm characteristics. Based on this stratification, female patients were matched to male patients in a 1:1 ratio with a caliper width of 0.1 using propensity score matching. Endpoints included postoperative complications, neurological performance, and aneurysm occlusion at discharge and 24 months after clip placement. RESULTS A total of 2245 patients with a mean age of 57.3 (range 20–87) years were included. Of these patients, 1675 (74.6%) were female. Female patients were significantly older (mean 57.6 vs 56.4 years, p = 0.03) but had fewer comorbidities. Aneurysms of the internal carotid artery (7.1% vs 4.2%), posterior communicating artery (6.9% vs 1.9%), and ophthalmic artery (6.0% vs 2.8%) were more commonly treated surgically in females, while clipping of aneurysms of the anterior communicating artery was more frequent in males (17.0% vs 25.3%; all p < 0.001). After propensity score matching, female patients were found to have had significantly fewer pulmonary complications (1.4% vs 4.2%, p = 0.01). However, general morbidity (24.5% vs 25.2%, p = 0.72) and mortality (0.5% vs 1.1%, p = 0.34), as well as neurological performance (p = 0.58), were comparable at discharge in both sexes. Lastly, rates of aneurysm occlusion at the time of discharge (95.5% vs 94.9%, p = 0.71) and 24 months after surgery (93.8% vs 96.1%, p = 0.22) did not significantly differ between male and female patients. CONCLUSIONS Despite overall differences between male and female patients in demographics, comorbidities, and treated aneurysm location, sex did not relevantly affect surgical performance or perioperative complication rates.
AB - OBJECTIVE Disparities in the epidemiology and growth rates of aneurysms between the sexes are known. However, little is known about sex-dependent outcomes after microsurgical clipping of unruptured intracranial aneurysms (UIAs). The aim of this study was to examine sex differences in characteristics and outcomes after microsurgical clipping of UIAs and to perform a propensity score–matched analysis using an international multicenter cohort. METHODS This retrospective cohort study involved the participation of 15 centers spanning four continents. It included adult patients who underwent clipping of UIAs between January 2016 and December 2020. Patients were stratified according to their sex and analyzed for differences in morbidities and aneurysm characteristics. Based on this stratification, female patients were matched to male patients in a 1:1 ratio with a caliper width of 0.1 using propensity score matching. Endpoints included postoperative complications, neurological performance, and aneurysm occlusion at discharge and 24 months after clip placement. RESULTS A total of 2245 patients with a mean age of 57.3 (range 20–87) years were included. Of these patients, 1675 (74.6%) were female. Female patients were significantly older (mean 57.6 vs 56.4 years, p = 0.03) but had fewer comorbidities. Aneurysms of the internal carotid artery (7.1% vs 4.2%), posterior communicating artery (6.9% vs 1.9%), and ophthalmic artery (6.0% vs 2.8%) were more commonly treated surgically in females, while clipping of aneurysms of the anterior communicating artery was more frequent in males (17.0% vs 25.3%; all p < 0.001). After propensity score matching, female patients were found to have had significantly fewer pulmonary complications (1.4% vs 4.2%, p = 0.01). However, general morbidity (24.5% vs 25.2%, p = 0.72) and mortality (0.5% vs 1.1%, p = 0.34), as well as neurological performance (p = 0.58), were comparable at discharge in both sexes. Lastly, rates of aneurysm occlusion at the time of discharge (95.5% vs 94.9%, p = 0.71) and 24 months after surgery (93.8% vs 96.1%, p = 0.22) did not significantly differ between male and female patients. CONCLUSIONS Despite overall differences between male and female patients in demographics, comorbidities, and treated aneurysm location, sex did not relevantly affect surgical performance or perioperative complication rates.
KW - UIA
KW - aneurysm
KW - cerebrovascular
KW - microsurgical
KW - sex
KW - unruptured intracranial aneurysm
KW - vascular disorders
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U2 - 10.3171/2024.3.JNS2484
DO - 10.3171/2024.3.JNS2484
M3 - Article
C2 - 38820613
AN - SCOPUS:85208453122
SN - 0022-3085
VL - 141
SP - 1151
EP - 1158
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 5
ER -