Impact of Sex on Clinical Outcomes of Tandem Occlusion in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy. A Propensity-Matched Analysis

Background: Although mechanical thrombectomy (MT) represents the standard of care for ischemic stroke due to large-vessel occlusion (LVO), the impact of sex on outcomes in tandem occlusions remains unclear. We investigated sex-based differences in outcomes after MT for tandem occlusions.

Methods: This multicenter observational study included consecutive patients with tandem occlusion treated with MT across three stroke centers (2021-2023). Propensity score matching was performed. Primary outcomes were the 90-day favorable functional outcome (mRS 0-2) and mRS score shift. Secondary outcomes included favorable recanalization, 24-h early neurological improvement, and NIHSS median score. Safety outcomes were post-MT intracerebral hemorrhage and 90-day mortality.

Results: Of 635 patients (46.8% women), 289 women were matched to 289 men. There were no significant differences in primary, secondary, or safety outcomes between sexes. Subgroup analysis showed a lower rate of favorable 90-day mRS scores in women with diabetes compared to men. Women not receiving emergent carotid treatment had higher rates of favourable outcomes. No significant sex differences were found in other subgroups.

Conclusions: Women with anterior circulation tandem occlusions treated with MT have similar outcomes to men. However, women with diabetes and those treated with intracranial MT alone exhibited sex-specific differences. Further studies are needed to explore underlying mechanisms.