Sex-based differences in outcomes following endovascular therapy for anterior circulation large vessel occlusion: a pooled analysis of DEVT, RESCUE BT, and MARVEL trials

Background This study sought to characterize sex-specific treatment effects by comparing clinical outcomes between men and women undergoing EVT. Methods Analyses were based on the DEVT, RESCUE BT, and MARVEL databases. Men and women were matched using propensity score matching (PSM). The primary outcome was defined as the 90-day ordinal modified Rankin Scale score (mRS) distribution. Secondary outcomes included the favorite outcome (mRS 0 to 3), functional independence (mRS 0 to 2), and excellent outcome (mRS 0 to 1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Results Of 2,862 patients, 1,221 (42.7%) were women and 1,641 (57.3%) were men. After adjusting for covariates, there were no sex differences in 90-day ordinal mRS distribution (median [interquartile range], 3 [1–6] versus 3 [1–5], common odds ratio [OR], 1.02 [0.89–1.18], p = 0.741). The secondary outcomes demonstrated consistency with the primary findings, and the safety outcomes remained stable across men and women. After 1:1 PSM, the results remained consistent with the adjusted outcomes described above. Conclusion This pooled analysis demonstrated that no statistically significant differences were observed between men and women in clinical or safety outcomes following EVT for anterior circulation LVO. Furthermore, there was no evidence of interaction between sex and predefined subgroups in terms of treatment effect modification for EVT outcomes.