Vignan Yogendrakumar, MD MSc

Bala F, Casetta I, Nannoni S, Herlihy D, Goyal M, Fainardi E, Michel P, Thornton J, Power S, Saia V, et al. Sex-Related Differences in Outcomes After Endovascular Treatment of Patients With Late-Window Stroke. Stroke. 2022.

To date, differences in clinical outcomes between males and females undergoing endovascular therapy (EVT) within the early time window have not been observed. Outcome data in the late window (> 6 hours from symptom onset) stratified by sex remains limited. To that effect, Bala and colleagues sought to use data from the SOLSTICE Consortium to investigate potential differences in outcomes between males and females undergoing EVT in the late window.

The SOLSTICE Consortium is an individual-patient level analysis of data from select registries and clinical trials. Patient selection for EVT in the late window was based on collateral or perfusion imaging. Outcomes evaluated in this analysis include functional independence (mRS ≤ 2), mRS shift, mortality at 90 days, and symptomatic intracranial hemorrhage.

Of the 608 patients in this analysis, 307 (51%) were female. Functional independence at 90 days did not differ between the two sexes, and there was no difference in median mRS. Symptomatic intracranial hemorrhage and mortality rates were also similar between the two groups. Of note, an interaction between age and sex was observed: Males had a higher likelihood of mortality and symptomatic hemorrhage with increasing age.

The patient sample used in this study reflects routine clinical practice, and while there is a risk of selection bias, the generalizability of this study cohort is greater than most clinical trials. This study provides reassurances that females, who are often underrepresented in clinical trials, benefit to an equal degree from EVT, as compared to men. As highlighted in the observed interaction analysis, further investigations into sex differences in older patients are warranted.