Abstract

Introduction: Recent studies have demonstrated widespread underrepresentation of women in acute stroke clinical trials. Identifying differences in internal carotid artery (ICA) stroke outcomes between males and females may be useful in aiding clinical management.  This international multicentre study aimed to determine sex differences in outcomes after mechanical thrombectomy (MT) for patients with acute ICA stroke.

Methods: We performed a retrospective analysis of consecutive patients with ICA stroke who had undergone MT in seven stroke centers across three countries (Germany, the United Kingdom, and Sweden) between 2015 and 2020. The primary outcome was a favorable functional outcome measured by a modified Ranking Scale (mRS) of 0–3 at 90 days. Secondary outcomes were mRS 0–3 upon discharge, mortality, and symptomatic intracranial hemorrhage (sICH).

Results: Among the 239 patients who underwent MT, 109 (45.6%) were male and 130 (54.4%) were female. Females were older than males (mean ± SD 72.7 ± 15.2 years vs. 67.0 ± 13.5 years; p < 0.001) and had higher rates of cardioembolic etiology of stroke (53.1% vs 35.5% p= 0.028). More males were smokers than females (21.6% vs 10.3%; p-0.021). Despite these differences, females had better primary and secondary outcome measures compared to males, with higher rates of favorable 90-day mRS scores (OR=2.78; 95% CI 1.33 – 5.81; p-0.007) and favorable discharge mRS scores (OR=2.49; 95% CI 1.25 – 4.98; p=0.010). Rates of complications such as sICH and SAH were comparably low in both groups.

Conclusion: Females achieved comparable functional outcomes compared with males after undergoing MT for ICA acute ischemic stroke.