Sex Differences in Management and Outcomes of Acute Ischemic Stroke With Large Vessel Occlusion

Background and Purpose- Sex differences in the management and outcomes of acute ischemic stroke with large vessel occlusion are unknown in the era of endovascular therapy (EVT). This study investigated these differences in the RESCUE (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism)-Japan Registry 2 patient database. Methods- RESCUE-Japan Registry 2 registered patients with large vessel occlusion who were admitted within 24 hours of onset were enrolled in this study. We estimated the likelihood to receive EVT according to sex. The primary outcome was good outcome defined as a modified Rankin Scale score of 0 to 2 at 90 days after onset. Secondary outcomes were mortality within 90 days, any or symptomatic intracranial hemorrhage within 72 hours, and recurrence of stroke or transient ischemic attack within 90 days. Results- Among 2399 patients, 1087 patients were female and 1312 were male; 47.9% of females and 57.7% of males received EVT (adjusted odds ratio, 0.71; 95% CI, 0.59-0.86). Good outcome was observed in 27.3% and 44.2% of the females and males, respectively (P<0.0001). The adjusted odds ratio of a good outcome in females was 0.80 (95% CI, 0.65-0.99). Mortality was 12.3% and 9.9% in females and males, respectively (P=0.06); the adjusted odds ratio was 0.78 (95% CI, 0.58-1.05). Conclusions- Females with acute ischemic stroke with large vessel occlusion showed poor functional outcome compared to males. Females were less likely to receive EVT; lower utilization of EVT accounted for a portion of the poor outcome.