TY - JOUR T1 - Sex differences in endovascular thrombectomy outcomes in large vessel occlusion: a propensity-matched analysis from the SELECT study JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 105 LP - 112 DO - 10.1136/neurintsurg-2021-018348 VL - 15 IS - 2 AU - Johanna T Fifi AU - Thanh N Nguyen AU - Sarah Song AU - Anjail Sharrief AU - Deep Kiritbhai Pujara AU - Faris Shaker AU - Lauren E Fournier AU - Erica M Jones AU - Colleen G Lechtenberg AU - Sabreena J Slavin AU - Nneka L Ifejika AU - Maria V Diaz AU - Sheryl Martin-Schild AU - Joanna Schaafsma AU - Jenny P Tsai AU - Anne W Alexandrov AU - Stavropoula I Tjoumakaris AU - Amrou Sarraj A2 - , Y1 - 2023/02/01 UR - http://jnis.bmj.com/content/15/2/105.abstract N2 - Background Sex disparities in acute ischemic stroke outcomes are well reported with IV thrombolysis. Despite several studies, there is still a lack of consensus on whether endovascular thrombectomy (EVT) outcomes differ between men and women.Objective To compare sex differences in EVT outcomes at 90-day follow-up and assess whether progression in functional status from discharge to 90-day follow-up differs between men and women.Methods From the Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) prospective cohort study (2016–2018), adult men and women (≥18 years) with anterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery M1/M2) treated with EVT up to 24 hours from last known well were matched using propensity scores. Discharge and 90-day modified Rankin Scale (mRS) scores were compared between men and women. Furthermore, we evaluated the improvement in mRS scores from discharge to 90 days in men and women using a repeated-measures, mixed-effects regression model.Results Of 285 patients, 139 (48.8%) were women. Women were older with median (IQR) age 69 (57–81) years vs 64.5 (56–75), p=0.044, had smaller median perfusion deficits (Tmax >6 s) 109 vs 154 mL (p<0.001), and had better collaterals on CT angiography and CT perfusion but similar ischemic core size (relative cerebral blood flow <30%: 7.6 (0–25.2) vs 11.4 (0–38) mL, p=0.22). In 65 propensity-matched pairs, despite similar discharge functional independence rates (women: 42% vs men: 48%, aOR=0.55, 95% CI 0.18 to 1.69, p=0.30), women exhibited worse 90-day functional independence rates (women: 46% vs men: 60%, aOR=0.41, 95% CI 0.16 to 1.00, p=0.05). The reduction in mRS scores from discharge to 90 days also demonstrated a significantly larger improvement in men (discharge 2.49 and 90 days 1.88, improvement 0.61) than in women (discharge 2.52 and 90 days 2.44, improvement 0.08, p=0.036).Conclusion In a propensity-matched cohort from the SELECT study, women had similar discharge outcomes as men following EVT, but the improvement from discharge to 90 days was significantly worse in women, suggesting the influence of post-discharge factors. Further exploration of this phenomenon to identify target interventions is warranted.Trial registration number NCT02446587.The data that support the findings of this study are available from the corresponding author upon reasonable request. ER -