Sex differences in endovascular thrombectomy: A comparative analysis of baseline characteristics, time metrics, interventional radiology techniques, and clinical outcomes

Purpose

To investigate differences in the baseline risk factors, stroke characteristics, procedural techniques, workflow processing times, and clinical outcomes between male and female endovascular thrombectomy (EVT) patients.

Materials and methods

This retrospective cohort study analyzed medical records of adult patients with acute ischemic stroke treated with EVT at a comprehensive stroke center from February 1, 2015, to May 31, 2022. The primary outcome was functional neurological disability, scored using the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included procedural workflow time delays, successful reperfusion rate, and other EVT technical aspects. Categorical data was evaluated through Fisher’s exact test and continuous data through Mann-Whitney U tests.

Results

A total of 943 patients consisting of 480 male and 463 female patients were included. Female patients were more likely to be older (p < 0.0001), and present with atrial fibrillation (p = 0.0089), and cardioembolic strokes (p < 0.0001). Male patients demonstrated higher rates of smoking (p = 0.030), coronary artery disease (p = 0.0004), large artery atherosclerotic strokes (p < 0.0001), and posterior circulation occlusion (p = 0.03). Median mRS scores at 90 days were similar between groups (mRS 1, p = 0.15). There were no differences in EVT technique and workflow time metrics between groups, however, female patients were more likely to present during business versus on-call hours (44.1% vs 37.3%, p = 0.040).

Conclusions

Female patients undergoing EVT demonstrated no difference in EVT outcomes, and were more likely to present during business hours. Female patients were older, and were more likely to present with atrial fibrillation, and cardioembolic strokes.