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Sex Differences in Screening for Large Vessel Occlusion and Thrombectomy: A Population-Based Cohort Study
Yasodara P S Siddharthan1, Moira K Kapral2, Jiming Fang3
1Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, ON, Canada (Y.P.S.S., A.Y.X.Y.).
Stroke
|July 10, 2026
Summary
Female stroke patients received less neuroimaging but had more large vessel occlusions (LVO). Thrombectomy outcomes were better for females with LVO, highlighting disparities in acute ischemic stroke care.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Sex differences in large vessel occlusion (LVO) screening and treatment for acute ischemic stroke are not well understood.
- Investigating disparities in detection, treatment, and outcomes is crucial for equitable stroke care.
Purpose of the Study:
- To compare sex-based differences in LVO detection, thrombectomy utilization, and long-term clinical outcomes among patients with cerebral ischemia.
- To identify potential sex-based disparities in acute ischemic stroke care pathways.
Main Methods:
- Retrospective cohort study using the Ontario Stroke Registry and linked health administrative data (2019-2023).
- Included adult patients hospitalized for cerebral ischemia within 24 hours of last seen normal.
- Used modified Poisson and Cox proportional hazard models to analyze sex differences in neuroimaging, thrombectomy, and long-term outcomes.
Main Results:
- Females were less likely to receive intracranial neurovascular imaging but more likely to have LVO detected.
- Overall thrombectomy use was higher in females, but similar when restricted to patients with LVO.
- Female patients with LVO who received thrombectomy had a lower adjusted hazard of adverse long-term outcomes compared to males.
Conclusions:
- Female patients with acute ischemic stroke are less likely to undergo neuroimaging but more likely to have LVO.
- Long-term mortality was lower in females with LVO who received thrombectomy.
- Stroke research must consider neuroimaging and LVO status to accurately identify and address sex-based disparities in stroke care.
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