Biological Sex and Outcomes in Patients with Extracranial Cervical Arterial Dissections

Background and Aims: Cervical arterial dissections (CeAD) are a common cause of stroke in young adults across both sexes. Whether biological sex plays a role in the pathogenesis and outcome of CeAD remains unclear. Methods: In this retrospective analysis of a cohort of patients with CeAD, clinical, imaging, treatment, and outcome data were compared between females and males using multivariate logistic regressions to identify outcome predictors. Propensity score matching (PSM) was used to adjust for imbalances between the groups. Results: Overall, 135 participants were included (79 males and 56 females, median age 44, interquartile range [IQR] 36, 50.5). Of those, 71 patients (53%) were diagnosed with stroke (median age 46, IQR 39.5, 52, median admission NIHSS 3, IQR 1, 7.5). Males had significantly higher rates of smoking (38% vs. 11%, p = 0.0004) but other baseline characteristics did not differ between the groups. Traumatic dissections were numerically more common in men but the difference between the groups did not reach significance. The presence of flame shaped lesion in the extra cranial vessel was more common among men in the initial analysis of the whole group but did not remain significant after PSM. No differences were observed between the groups regarding treatment strategies including administration of systemic thrombolysis and stent placements. The rates of recurrent stroke and recurrent dissections were similar. Favorable outcomes defined as modified Rankin Score (mRS) ≤ 2 and symptomatic intracranial hemorrhage rates were also similar on the univariate analyses and did not change after PSM. Age (odds ratio [OR] 1.12, 95% confidence intervals [CI] 1.04-1.23) and admission NIHSS (OR 0.74, 95%CI 0.60-0.84) were associated with outcomes on regression analysis whereas female sex was not (OR 0.54, 95% CI 0.03-5.87). Conclusions: CeAD occurs more frequently in males, who are more likely to have associated risk factors and traumatic neck injuries. However, sex does not appear to impact outcome in CeAD patients.