# Biological Sex and Outcomes in Patients with Extracranial Cervical Arterial Dissections

## TL;DR

This study finds that while cervical arterial dissections are more common in males, biological sex does not affect outcomes like stroke recurrence or treatment success.

## Contribution

The study is one of the first to systematically analyze the impact of biological sex on outcomes in cervical arterial dissection patients using propensity score matching.

## Key findings

- Males had higher rates of smoking and traumatic dissections but similar outcomes compared to females.
- Biological sex was not a significant predictor of favorable outcomes or complications after adjusting for confounders.
- Age and initial stroke severity were significant predictors of outcomes, but not sex.

## Abstract

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.