Sex Disparities in Mortality After Endovascular Therapy in Large Core Infarcts.

Area of Science:

• Neurology
• Cardiovascular Diseases
• Public Health

Background:

• Large vessel occlusion acute ischemic stroke (AIS) is a critical condition with significant mortality.
• Recent endovascular therapy (EVT) trials show reduced mortality in AIS patients.
• Societal and biological factors may influence post-AIS mortality differently between sexes.

Purpose of the Study:

• To investigate sex-based differences in mortality outcomes following EVT in large core AIS.
• To determine if EVT impacts mortality differently in women versus men with large core AIS.

Main Methods:

• Retrospective analysis of a prospectively collected multicenter registry (2017-2022).
• Inclusion criteria: large vessel occlusion AIS and large infarct core (CT perfusion >70 mL or CTAGS <6).
• Primary outcome: 90-day mortality, analyzed using multivariable logistic regression with adjustment for EVT, sex, and interaction terms.

Main Results:

• 190 patients included; 50% female. Women presented at an older age (75 vs. 67 years).
• Multivariable analysis revealed non-EVT management strongly associated with increased mortality in women vs. men at discharge (OR 5.81) and 90 days (OR 6.77).
• Significant sex/EVT interaction for mortality at discharge and 90 days (P<0.01), indicating differential treatment effects.

Conclusions:

• Endovascular therapy (EVT) for large core AIS may disproportionately reduce mortality in women compared to men.
• Findings highlight potential sex-specific benefits of EVT in acute ischemic stroke management.