Sex-Related Differences in Endovascular Treatment Outcomes for Acute Large Infarcts: The ANGEL-ASPECT Subgroup Analysis

Background and Purpose The outcomes of endovascular therapy (EVT) across sexes for large infarcts remains unclear. This study aimed to evaluate the impact of sex on the outcomes of EVT for patients with large infarct. Methods In this secondary analysis of the ANGEL-ASPECT trial, we compared baseline characteristics and clinical outcomes between men and women, and each cohort further divided into EVT and medical management (MM) groups. The primary outcome was the 90-day modified Rankin Scale (mRS) score distribution. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality within 90 days. Results There were 177 of 455 patients enrolled in the ANGEL-ASPECT trial who were women. 53.7% (95/177) of women and 48.6% (135/278) of men underwent EVT, respectively. The treatment effect of EVT didn’t vary in both sexes with large infarcts (all P >0.05 for interaction). Compared to MM, EVT improved 90-day functional outcomes for both men (3[2-5] vs. 4[3-5], common odds ratio [cOR]: 1.92, 95% CI: 1.26–2.95, P=0.003) and women (4[3-6] vs. 5[4-6], cOR: 2.50, 95% CI: 1.41–4.44, P=0.002). The sICH rate wasn’t different in both treatment groups across both sexes (Men: 5.2% vs. 2.8%, RR: 2.04, 95%CI: 0.56-7.47, P=0.28; Women:7.4% vs. 2.4%, RR:3.00, 95%CI:0.57-15.68, P=0.19). Conclusion In patients with large ischemic infarct, the treatment effect of EVT didn’t differ between women and men, with better outcomes with EVT versus MM, without an increased risk of sICH. These findings emphasize the need for equal attention and care for both sexes with large infarcts in clinical practice.