Sex differences in outcomes of dural arteriovenous fistula treatment in Japan: Analysis of the Japanese Registry of Neuroendovascular Therapy (JR-NET 4)

OBJECTIVE: Sex differences in outcomes after endovascular treatment (EVT) for dural arteriovenous fistula (dAVF) remain unclear. This study aimed to compare 30-day complications and outcomes between women and men using data from the Japanese Registry of Neuroendovascular Therapy registry in Japan. METHODS: We analyzed data from a nationwide retrospective registry (2015-2019), comparing outcomes between women and men who underwent EVT for dAVFs. The primary outcome was worsening of modified Rankin Scale (mRS) score ≥ 2 at 30 days after EVT. Secondary outcomes included 30-day morbidity, defined as any procedure-related complication such as intracranial hemorrhage or ischemic stroke, favorable outcome (mRS 0-2), and mortality. RESULTS: Among 3156 patients (1561 women, 1532 men; mean age 68.8 vs. 63.8 years, p < 0.0001), dAVF location and preprocedural symptoms differed significantly by sex. Worsening of mRS ≥ 2 occurred in 7.1% of women and 11.6% of men (adjusted odds ratio [aOR] 0.84; 95% CI 0.64-1.11; p = 0.23). Thirty-day morbidity was similar (5.3% vs. 5.4%; aOR 1.07; 95% CI 0.77-1.48). Hemorrhagic complications were more frequent in women (1.9% vs. 1.3%; aOR 1.93; 95% CI 1.07-3.50). Favorable outcomes were slightly more common in women (90.1% vs. 86.2%), and 30-day mortality was low in both groups (<1%). CONCLUSIONS: This large retrospective registry study found significant sex-based differences in dAVF location but no significant differences in worsening of mRS ≥ 2, 30-day morbidity or the rate of patients achieving a favorable mRS score at 30 days after EVT.