Sex-Related Differences in Outcomes of Endovascular Treatment for Anterior Circulation Large Vessel Occlusion
Authors: Sun Dapeng , Raynald  , Huo Xiaochuan , Jia Baixue , Tong Xu , Ma Gaoting , Wang Anxin , Ma Ning , Gao Feng , Mo Dapeng , Nguyen Thanh N. , Miao Zhongrong , Miao Zhongrong , Gui Liqiang , Song Cunfeng , Peng Ya , Wu Jin , Zhao Shijun , Zhao Junfeng , Zhou Zhiming , Li Yongli , Jing Ping , Yang Lei , Liu Yajie , Zhao Qingshi , Liu Yan , Peng Xiaoxiang , Gao Qingchun , Guo Zaiyu , Chen Wenhuo , Li Weirong , Cheng Xiaojiang , Xu Yun , Zhang Yongqiang , Zhang Guilian , Lu Yijiu , Lu Xinyu , Wang Dengxiang , Wang Yan , Li Hao , Hua Yang , Geng Deqin , Yuan Haicheng , Wang Hongwei , Yang Haihua , Wang Zengwu , Wei Liping , Liufu Xuancong , Shi Xiangqun , Li Juntao , Yang Wenwu , Jing Wenji , Yong Xiang , Wang Leyuan , Li Chunlei , Cao Yibin , Zhu Qingfeng , Zhang Peng , Luo Xiang , Chen Shengli , Peng WenWu , Wang Lixin , Wen Xue , Shi Shugui , Wang Wanming , Bo Wang , Yuan Pu , Wang Dong , Guan Haitao , Liang Wenbao , Ma Daliang , Chen Long , Xiao Yan , Xie Xiangdong , Shi Zhonghua , Zeng Xiangjun , Su Fanfan , Chang MingZe , Yin Jijun , Sun Hongxia , Li Chong , Bi Yong , Xie Gang , Zhao Yuwu , Wang Chao , Zhang Peng , Wang Xianjun , Li Dongqun , Liang Hui , Chen Zhonglun , Wang Yan , Wang Yuxin , Yin Lin , Qiu HongKai , Wei Jun , Sun Yaxuan , Feng Xiaoya , Wu Weihua , Gao Lianbo , Ai Zhibing , Tan Lan , Ding Li , Liang Qilong , Wang Zhimin , Yang Jianwen , Xu Ping , Dong Wei , Zheng Quanle , Zhu Zhenyun , Zhao Liyue , Meng Qingbo , Wei Yuqing , Chen Xianglin , Wang Wei , Sun Dong , Yan Yongxing , Yuan Guangxiong , Yang Yadong , Zhou Jianfeng , Yang Zhi , Zhang Zhenzhong , Guan Ning , Wang Huihong 
Published: January 2023

Background:
Sex disparities in acute large vessel occlusion (LVO) following endovascular treatment (EVT) have been recently reported. However, there is uncertainty about the effect of sex differences on functional outcomes after EVT, particularly in an Asian population. The present study aimed to compare the clinical and safety outcomes between men and women with anterior circulation LVO treated with EVT.

Methods:
We analyzed data from the ANGEL-ACT (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke: a Prospective Multicenter Registry Study) Registry, which was conducted at 111 hospitals from 26 provinces in China between November 2017 and March 2019. Men and women with anterior circulation LVO treated with EVT were matched using propensity scores. After a 1:1 propensity score matching, we compared the clinical outcomes including 90-day ordinal modified Rankin Scale distribution (primary outcome), procedure duration, successful reperfusion, symptomatic intracranial hemorrhage, and mortality. Furthermore, we explored sex modification on the primary outcome in subgroup analysis.

Results:

Of 1321 patients, 483 (36.6%) were women and 838 (63.4%) were men. The mean age for women and men were 68 and 62 years old, respectively. Among 578 patients identified after matching, there were no sex differences (men versus women) in 90-day ordinal modified Rankin Scale distribution (median [interquartile range], 4 [1–5] versus 3 [1–5],
P
=0.464), successful reperfusion (86.5% versus 91.0%,
P
=0.089), symptomatic intracranial hemorrhage (6.5% versus 7.9%,
P
=0.512), and mortality within 90 days (17.7% versus 17.0%,
P
=0.826). However, men had a longer median procedure duration than women (86 [52–128] versus 72 [48–110] minutes, β=14.51, [95% CI, 4.19–24.84];
P
=0.006). Subgroup analysis showed that in patients with National Institutes of Health Stroke Scale score <15, women tended to have a better outcome than men, whereas there was no gender effect in those with National Institutes of Health Stroke Scale score ≥15 (
P
for interaction=0.032).

Conclusions:
Overall, this matched-control study from the ANGEL-ACT study showed similar clinical outcomes between men and women with anterior circulation LVO treated with EVT. However, in the subgroup of patients presenting with lower stroke severity (ie, National Institutes of Health Stroke Scale score <15), women tended to have a better outcome than men highlighting a potential sex disparity for further investigation.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03370939.