Sex Differences in Screening for Large Vessel Occlusion and Thrombectomy: A Population-Based Cohort Study.

BACKGROUND

Population-based sex differences in large vessel occlusion (LVO) screening and thrombectomy use for acute ischemic stroke are not well understood. We compared the detection of LVO, thrombectomy use, and long-term clinical outcomes in female versus male patients with cerebral ischemia in Ontario, Canada.

METHODS

This retrospective cohort study used data from the Ontario Stroke Registry linked with health administrative data. We included adult patients hospitalized for cerebral ischemia within the first 24 hours of last seen normal time during 2 fiscal years (2019/2020 and 2022/2023). We used modified Poisson regression models to evaluate sex differences in intracranial neurovascular imaging, thrombolysis, or thrombectomy. Among patients with LVO, we used Cox proportional hazard and cause-specific hazard models to compare female versus male patients long-term mortality, readmission, or nursing home admission until 2025, stratified by thrombectomy treatment.

RESULTS

Among 16 935 eligible patients (47% female patients; median age, 76 [interquartile range, 65-84] years), female patients were less likely than male patients to receive intracranial neurovascular imaging (83.6% female versus 87.8% male; P<0.01). Among those who underwent imaging, 19.3% of female patients had an LVO compared with 15.9% of male patients (P<0.01). Thrombectomy use was higher in female patients than male patients in the overall cohort (adjusted relative risk, 1.08 [1.01-1.16]), but, once restricted to those with LVO, thrombectomy use was similar (adjusted relative risk, 0.98 [0.93-1.03]). Adjusted hazard of the composite outcome was lower in female patients with LVO treated with thrombectomy compared with their male counterparts (adjusted hazard ratio, 0.88 [0.77-0.99]).

CONCLUSIONS

Female patients with acute cerebral ischemia were less likely than male patients to receive intracranial neurovascular imaging but more likely to have an LVO, and long-term mortality was lower in female patients with LVO treated with thrombectomy. Stroke outcomes' research must account for neurovascular imaging and LVO status to accurately identify sex-based disparities in stroke care and outcomes.