Sex Differences in Prognostic Markers: Exploring Outcome Variability After Mechanical Thrombectomy in Large Vessel Occlusion Stroke

Background: Sex-related disparities in long-term outcomes after large vessel occlusion (LVO) following mechanical thrombectomy (MT) have been repeatedly shown. Notably, a lower likelihood of achieving functional independence 90 days post-stroke has been found in women. However, most studies showed equal outcomes for both sexes after MT. It remains unclear whether there are sex differences in the prognostic values of clinical and neuroradiological parameters. Our investigation aimed to discern the divergent prognostic values of multiple markers between sexes. Methods: We retrospectively examined 183 stroke patients with LVO who received MT. Using multivariable logistic regression models, we investigated sex-specific associations of various parameters, including ASPECTS, lesion core volume, penumbra volume, collateral status, and time to reperfusion, concerning outcomes at discharge and 90 days post-stroke. Results: We observed no significant difference between men and women in achieving a favorable outcome defined as modified Rankin Scale (mRS) 0–2. However, when considering the full mRS, women exhibited less favorable overall outcomes. In women, NIHSS, TICI score, and penumbra volume were associated with outcome, whereas in men, core lesion volume and ASPECTS were associated. Age was the only factor associated with outcome in both sexes. Conclusions: Considering the full spectrum of mRS may provide more sophisticated understanding of sex-related outcome differences. Further, these findings highlight the importance sex-specific prognostic factors in outcome assessment. Unraveling sex-specific prognostic biomarkers of recovery has the potential to advance precision medicine and personalized clinical management in stroke.