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Original research
Endovascular treatment decision in acute stroke: does physician gender matter? Insights from UNMASK EVT, an international, multidisciplinary survey
  1. Johanna Maria Ospel1,2,
  2. Nima Kashani3,
  3. Alexis T Wilson2,
  4. Urs Fischer4,
  5. Bruce C V Campbell5,6,
  6. Pillai N Sylaja7,
  7. Shinichi Yoshimura8,
  8. Alejandro A Rabinstein9,
  9. Francis Turjman10,
  10. Peter Mitchell11,
  11. Byung Moon Kim12,
  12. Mathew P Cherian13,
  13. Ji Hoe Heo14,
  14. Blaise W Baxter15,
  15. Anna Podlasek16,
  16. Mona Foss17,
  17. Bijoy K Menon2,3,
  18. Mohammed A Almekhlafi2,3,
  19. Andrew M Demchuk2,3,
  20. Michael D Hill2,3,
  21. Gustavo Saposnik18,
  22. Mayank Goyal2,3
  1. 1 Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
  2. 2 Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  3. 3 Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  5. 5 Department of Medicine, University of Melbourne, Parkville, VIctoria, Australia
  6. 6 Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  7. 7 Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  8. 8 Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
  9. 9 Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States
  10. 10 Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Lyon, Lyon, France
  11. 11 Department of Radiology, Royal Melbourne Hospital, Melbourne, Australia
  12. 12 Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
  13. 13 Radiology, Kovai Medical Center, Coimbatore, Tamil Nadu, India
  14. 14 Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
  15. 15 University of Tennessee, College of Medicine, Chattanooga, Tennessee, United States
  16. 16 Neuroscience and Vascular Simulation, Anglia Ruskin University, Chelmsford, UK
  17. 17 Bootstrap Analytics, Calgary, Alberta, Canada
  18. 18 Division of Neurology, Department of Medicine, St Michael’s Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Dr Mayank Goyal, Diagnostic Imaging, University of Calgary, Calgary, AB T2N2T9, Canada; mgoyal{at}


Background and purpose Differences in the treatment practice of female and male physicians have been shown in several medical subspecialties. It is currently not known whether this also applies to endovascular stroke treatment. The purpose of this study was to explore whether there are differences in endovascular treatment decisions made by female and male stroke physicians and neurointerventionalists.

Methods In an international survey, stroke physicians and neurointerventionalists were randomly assigned 10 case scenarios and asked how they would treat the patient: (A) assuming there were no external constraints and (B) given their local working conditions. Descriptive statistics were used to describe baseline demographics, and the adjusted OR for physician gender as a predictor of endovascular treatment decision was calculated using logistic regression.

Results 607 physicians (97 women, 508 men, 2 who did not wish to declare) participated in this survey. Physician gender was neither a significant predictor for endovascular treatment decision under assumed ideal conditions (endovascular therapy was favored by 77.0% of female and 79.3% of male physicians, adjusted OR 1.03, P=0.806) nor under current local resources (endovascular therapy was favored by 69.1% of female and 76.9% of male physicians, adjusted OR 1.03, P=0.814).

Conclusion Endovascular therapy decision making between male and female physicians did not differ under assumed ideal conditions or under current local resources.

  • stroke
  • thrombectomy

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  • Contributors JMO: data analysis, interpretation of the data, drafting and revision of the manuscript, and figures. NK: data collection, interpretation of the data, crafting and revision of the figures, and critical revision of the manuscript. MG: data collection, fundraising, interpretation of the data, and drafting and critical revision of the manuscript. BKM, BCVC, UF, FT, PM, SY, AP, AAR, ATW, BMK, BWB, MPC, JHH, MF, AMD, PNS, and MDH: interpretation of the data, and critical revision of the manuscript. GS: data collection, interpretation of the data, and critical revision of the manuscript. MAA: data collection, drafting, interpretation of the data, and critical revision of the manuscript.

  • Funding This work was supported by Stryker Inc through an unrestricted research grant to the University of Calgary. The company was not involved in the design, execution, analysis, and interpretation or reporting of the results.

  • Competing interests None declared.

  • Ethics approval Approval by the localresearch ethics board was obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.