Sex-based heterogeneity in outcomes following frontline EVT strategies for anterior circulation stroke
Year: 2026
Type: article
Abstract: Background Endovascular thrombectomy (EVT) is the standard treatment for large vessel occlusion stroke, with stent retriever (SR) and contact aspiration (CA) as the predominant frontline techniques. Although sex-related differences in EVT outcomes are increasingly recognized, whether the comparative effectiveness of SR versus CA differs by sex remains unclear. This study evaluated sex-related heterogeneity in outcomes between frontline SR and CA using the Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). Methods TREAT-AIS is a multicenter prospective EVT registry. Patients with anterior circulation stroke who received frontline SR or CA alone were included; those treated with combined techniques were excluded. We assessed the EVT technique-by-sex interaction in the overall cohort and performed sex-stratified propensity score matching (PSM) to evaluate 3-month functional and safety outcomes. Results Of 1,752 patients, a significant technique-by-sex interaction was observed for independent functional outcome (modified Rankin Scale 0–2; P for interaction = 0.016): CA was associated with this outcome among female (adjusted odds ratio [aOR], 3.39; 95% CI, 1.40–10.18) but not male patients (aOR, 0.87; 95% CI, 0.50–1.56). After 1:4 PSM, independent functional outcome was more frequent with CA than with SR among female (26.0% vs. 8.6%; aOR, 3.94; 95% CI, 1.11–14.02) but not male patients (35.1% vs. 38.1%; aOR, 0.73; 95% CI, 0.35–1.53). A similar nonsignificant trend was observed for ambulatory functional outcome in female patients, whereas symptomatic intracranial hemorrhage and mortality were comparable in both sexes. Conclusions This registry suggests potential sex-related heterogeneity in outcomes across frontline EVT strategies; these hypothesis-generating findings warrant validation in larger cohorts.
Source: Biology of Sex Differences
Authors: Yu-Ming Chang, Chih-Yuan Huang, Chung-Wei Lee, Yi-Chen Hsieh, Chun-Jen Lin, Yu-Wei Chen, Kuan-Hung Lin, Chih-Wei Tang, Hai-Jui Chu, Chuan-Hsiu Fu, Chao-Liang Chou, Ching-Huang Lin, Cheng-Yu Wei, Shang-Yih Yen, Po-Lin Chen, Kuan-Yu Lin, Lung Chan, Sheng-Feng Sung, Meng Lee, Hon-Man Liu, Chun-Ming Wang, Yen-Heng Lin, Pi-Shan Sung, I-Hui Lee, Sung-Chun Tang, Jiunn-Tay Lee, Li-Ming Lien, Hung-Yi Chiou, Jiann-Shing Jeng
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,290
OpenAlex ID: W7225263731
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