Sex and Age Differences in Outcomes After Endovascular Thrombectomy of Patients With Acute Ischemic Stroke and Atrial Fibrillation: A Danish Nationwide Study

Background Sex disparities in outcomes after endovascular thrombectomy (EVT) for large vessel occlusion stroke in patients with atrial fibrillation (AF) remain unclear. This study examined sex differences in outcomes following EVT according to AF status. Methods Using the nationwide Danish Stroke Registry, adults with first‐time ischemic stroke involving anterior and posterior circulation large vessel occlusion treated with EVT from 2015 to 2020 were included. Outcomes included 90‐day good functional outcome (modified Rankin Scale score ≤2), successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b), symptomatic intracranial hemorrhage, and mortality. Multivariable logistic regression assessed associations between AF and outcomes stratified by sex, including sex‐and‐age interactions. Results Among 2542 EVT‐treated patients (median age 72.5 years; 43.2% women), 729 (28.7%) had AF. Women with AF had higher odds of good functional outcome than women without AF (adjusted OR [aOR], 1.48 [95% CI, 1.10–1.99]). Men with AF had similar odds of good functional outcome as men without AF (aOR, 1.17 [95% CI, 0.90–1.53]) but higher odds of successful reperfusion (aOR, 2.04 [95% CI, 1.37–3.02]). No differences by sex or AF status were observed for excellent functional outcomes, symptomatic intracranial hemorrhage, or mortality. Among men, older men with AF was associated with higher odds of successful reperfusion compared with older men without AF ( P interaction <0.001). Conclusions Among patients undergoing EVT for large vessel occlusion stroke in Denmark, women with AF had higher odds of good functional outcome and men with AF showed higher successful reperfusion rates with advancing age. Safety and mortality outcomes were similar across groups with AF. These findings suggest age‐and sex‐specific influences on EVT outcomes associated with AF.