Abstract TP1: Sex Differences in Management and Outcomes of Acute Ischemic Stroke With Large Vessel Occlusion: Sub-Analysis of RESCUE-Japan Registry 2

Abstract

Background: Several studies have shown that women have a poorer prognosis after stroke than men. However, there were scanty data on sex difference in the management and clinical outcomes of acute ischemic stroke due to large vessel occlusion. Methods: Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Registry 2 in Japan registered patients with acute ischemic stroke due to large vessel occlusion who were admitted within 24 hours of onset from 2014 to 2017. We estimated the likelihood to receive endovascular therapy between the sexes. Primary outcome was good functional outcome defined by modified Rankin Scale (mRS) of 0-2 at 90 days after onset. Secondary outcome was the mortality within 90 days after onset. Adjusted odds ratio (OR) was estimated by logistic regression model accounted for potential confounders. Safety endpoints were all bleeding included intracerebral hemorrhage, recurrence of stroke within 90 days. Results: Among 2399 patients registered, 1087 patients were female and 1312 were male. Mean age was 80 and 73 years in female and male patients, respectively. Cardioembolic stroke consisted of 77% and 71% of female and male patients, respectively. 47.9% of female patients received the endovascular therapy compared with 57.7% in the counterparts (adjusted OR 0.69, 95%CI 0.58-0.83). Good outcome was observed in 27.3% and 44.2% the female and male patients, respectively (p<0.0001). Adjusted OR of good outcome of female relative to male was 0.79 (95%CI: 0.64-0.98). Subgroup analyses showed the female was good prognosis over 75 years old [adjusted OR 0.57 (95%CI 0.43-0.77) while not differ under 75 years old [adjusted OR 1.24 (95%CI 0.89-1.72)] (interaction p=0.0001). The mortality was 12.3% and 9.9% in female and male patients (p = 0.06), and adjusted OR was not also statistically significant. Conclusions: Female patients with acute cerebral large vessel occlusion has poor prognosis compared to male. Female patients were less likely to receive endovascular therapy than male but such lower utilization of endovascular therapy accounted for a part of poor prognosis in female patients. The causes of poor prognosis in female patients should be attested in addition to the improved access to endovascular therapy in female.