Sex differences in risk factors, stroke etiology, treatment characteristics, and outcomes after endovascular treatment for anterior circulation ischemic stroke
Abstract
Sex-specific differences in vascular risk factors, stroke etiology, and outcomes after endovascular treatment (EVT) remain uncertain. We investigated these differences in a contemporary single-center cohort. Consecutive patients with acute anterior circulation ischemic stroke undergoing EVT (with-/out intravenous thrombolysis) between February 2015 and March 2023 were included. Sex differences in risk factors, treatment, successful reperfusion, and 3-month outcomes (mRS ≤ 1, ≤ 2, and mortality) were examined; multivariable models included interactions with age, stroke etiology, and bridging therapy. Among 1,764 patients (median age 76 years, 48% women), women were older (79.4 vs. 73.3 years, p < 0.001) and more often had atrial fibrillation and chronic kidney disease, while men more frequently had coronary heart disease, diabetes, and smoking history. Cardioembolic stroke was more common in women, whereas large artery atherosclerosis was more frequent in men. Successful reperfusion rates did not differ by sex (overall: 86.2%, p = 0.084). At 3 months, men were more likely to achieve favorable functional outcome (mRS ≤ 2: 47.6% vs. 37.5%, p < 0.001) and excellent functional outcome (mRS ≤ 1: 31.4% vs. 25.6%, p = 0.008), while mortality was higher in women (31.9 vs. 24.9%, p = 0.001). Female sex was not independently associated with successful reperfusion (aOR: 0.79; 95%CI: 0.60–1.06), favorable outcome (0.88; 0.69–1.11), excellent outcome (0.93; 0.73–1.19), or mortality (1.06; 0.83–1.35). A sex-by-age interaction was observed for favorable outcome ( p interaction = 0.006), with no evidence of interaction by stroke etiology or bridging therapy. Women and men differ in risk profiles, stroke mechanisms, and unadjusted outcomes after EVT. However, sex was not independently associated with outcomes overall, although age may modify its association with favorable functional outcome.