Sex does not impact endovascular thrombectomy outcomes

In the treatment of patients presenting with large ischaemic stroke, endovascular thrombectomy (EVT) is beneficial to both women and men, with higher rates of functional independence and independent ambulation relative to medical management, according to a study.

Researchers conducted a subgroup analysis of the SELECT2* trial to examine whether there were sex-based differences in the efficacy and safety of EVT vs medical management. They compared baseline characteristics and clinical and imaging outcomes between women and men.

Regression models were applied to assess functional outcomes at 90-day and 1-year follow-up, with adjustment for potential confounders. Sex-related effect modification was also evaluated.

The analysis included 352 patients, of which 145 were women (41 percent). EVT was performed in 71 of 145 women (49 percent) and in 109 of 207 men (53 percent). At 90 days, the women and men who underwent EVT vs medical management had better functional outcomes (women: adjusted generalized odds ratio, 1.73; men: adjusted generalized odds ratio, 1.66; p=0.94 for interaction), functional independence (women: 20 percent vs 4 percent; adjusted risk ratio [aRR], 5.04, 95 percent CI, 1.59–16.02; men: 20 percent vs 9 percent; aRR, 1.99, 95 percent CI, 0.99–4.02; p=0.20 for interaction), and independent ambulation (women: 39 percent vs 16 percent; aRR, 2.44, 95 percent CI, 1.40–4.24; men: 38 percent vs 20 percent; aRR, 1.98, 95 percent CI, 1.29–3.03; p=0.67 for interaction). There was no significant heterogeneity.

Results at 1-years follow-up were similar.

In women, the rate of independent ambulation after EVT decreased as age increased (per year: aRR, 0.97, 95 percent CI, 0.95–0.99; p=0.004) and as core volume estimates increased (per mL increase: aRR, 0.99, 95 percent CI, 0.98–1.00; p=0.015). Similar associations were seen in men.

The findings suggest that EVT should be equally considered for both women and men who meet large core eligibility criteria.

*A Randomized Controlled Trial to Optimize Patient’s Selection for Endovascular Treatment in Acute Ischemic Stroke