Introduction Sex‐related differences in stroke etiology are well established. Given that endovascular thrombectomy (EVT) performance may be influenced by these factors, here we investigate sex‐based differences in reperfusion outcomes across EVT techniques. Materials/Methods From our multi‐center prospectively collected observational registry, we identified consecutive patients who underwent EVT for anterior circulation large vessel occlusion (LVO), including intracranial internal carotid artery (ICA) and the M1 and M2 segments of the middle cerebral artery (MCA) between January 2021 ‐ June 2024 across multiple centers in the Houston area. EVT techniques were categorized as stent retriever (SR), contact aspiration (CA), or combined technique (CT). The primary outcome was first pass effect (FPE), defined as mTICI 2c/3 after one pass. Secondary outcomes included achieving mTICI 2c/3 within two passes, 90‐days mRS of 0‐2, and rates of intracranial hemorrhages (ICH), sICH, and mortality. Multivariable logistic regressions were used for binary outcomes adjusted for age, NIHSS, atrial fibrillation, smoking, and prior thrombolysis. Linear regression was used for the number of thrombectomy passes. Results Among 724 patients that met inclusion criteria, 47% were female, median age was 68 years (IQR 54‐78), and NIHSS was 16 (IQR 11‐21). Presentation characteristics were balanced apart from greater rates of atrial fibrillation in females (23.0% vs. 16.6%, p < 0.05), and lower rates of intravenous thrombolysis in females (31% vs. 40%, p<0.05). EVT techniques were comparable between genders. The FPE across the cohort was similar (female vs. male, 37.9 % vs. 36.3%). In multivariable logistic regression, among females, CA was associated with greater odds of FPE (aOR = 2.17, 95% CI 1.07; 4,35) and greater odds of TICI 2c/3 reperfusion within 2 passes compared to SR (aOR= 2.63 (95% CI 1.32; 5.26). CA in females was associated with fewer passes compared to CA in men (β = 0.28, p < 0.05). No difference in reperfusion outcomes was seen between EVT techniques in the male subgroup. In the subgroup of patients receiving SR as their first pass, female sex was associated with decreased odds of achieving successful reperfusion within two passes (aOR = 0.43, 95% CI 0.19; 0.99) and achieving a favorable 90‐day functional outcome (mRS 0‐2), with an aOR of 0.21 (95% CI 0.05; 0.98). Conclusion In our multicenter observational cohort, females with anterior circulation LVO had better reperfusion outcomes with CA compared to SR, and they were less likely to achieve favorable outcomes when SR was used as a first pass. image
Samaha et al. (Sat,) studied this question.