Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Mar;32(3):e70092.
doi: 10.1111/ene.70092.

Sex-Related Differences in Outcomes of Endovascular Treatment in Large Vessel Occlusion Stroke-Analyses From the German Stroke Registry-Endovascular Treatment

Constanze Single  1 , Annerose Mengel  1   2 , Kornelia Laichinger  1   2 , Jennifer Sartor-Pfeiffer  1   2 , Nadja Selo  3 , Florian Hennersdorf  3 , Benjamin Bender  3 , Milani Deb-Chatterji  4 , Götz Thomalla  5 , Joshua Mbroh  1   2 , Sven Poli  1   2 , Ulf Ziemann  1   2 , Ulrike Ernemann  3 , Katharina Feil  1 ; German Stroke Registry—Endovascular Treatment (GSR)
Affiliations
Observational Study

Sex-Related Differences in Outcomes of Endovascular Treatment in Large Vessel Occlusion Stroke-Analyses From the German Stroke Registry-Endovascular Treatment

Constanze Single et al. Eur J Neurol. 2025 Mar.

Abstract

Background: Sex-related differences in acute ischemic stroke may affect outcomes, yet evidence remains inconsistent. This large-scale study investigated sex-related differences in clinical presentation, peri-interventional parameters, and outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) using data from the German Stroke Registry-Endovascular Treatment (GSR-ET).

Methods: We analyzed 11.896 EVT patients (52.2% female) from the GSR-ET (June 2015-December 2021) comparing clinical characteristics, treatment details, and outcomes by sex. Two propensity score matchings (PSM) were applied: (1) logistic regression model with a caliper width of 0.1 on age, pre-stroke modified Rankin Scale (pmRS), and National Institutes of Health Stroke Scale at admission, and (2) 1:1 nearest neighbor matching with a caliper of 0.01. Primary outcomes were good (mRS 0-2) and excellent (mRS 0-1) outcomes at discharge and 90-day follow-up.

Results: Women were older (76.3 ± 12.7 vs. 70.2 ± 12.9 years, p < 0.001) and had higher pre-stroke disability (median pmRS 0 (0, 2) vs. 0 (0, 1), p < 0.001). Cardioembolic strokes were more frequent in women, even after PSM. Despite this, women had better odds of achieving good outcomes at discharge (adjusted OR 1.20, 95% CI 1.04-1.38, p = 0.013), but not at follow-up (OR 0.91, 95% CI 0.78-1.05, p = 0.193). Both PSM analyses confirmed these findings.

Conclusions: While women demonstrated better short-term functional outcomes after EVT, these benefits diminished in follow-up. The persistence of cardioembolic stroke in women suggests potential sex-specific mechanisms. Understanding and addressing sex-related differences in stroke is essential to optimize acute stroke care and improve outcomes. Future studies should explore biological and socio-economic factors influencing sex-related differences.

Trial registration: ClinicalTrials.gov identifier: NCT03356392.

Keywords: acute management; endovascular thrombectomy; female; intensive care; intravenous thrombolysis; sex‐related differences; stroke.

PubMed Disclaimer

Conflict of interest statement

Constanze Single, Kornelia Laichinger, Jennifer Sartor‐Pfeiffer, Nadja Selo, Florian Hennersdorf, Benjamin Bender, Joshua Mbroh, and Ulrike Ernemann are reporting no disclosures. Annerose Mengel received grants from the University of Tübingen (AKF) and speakers' honoraria/consulting fees from AMGEN, all not related to this work. Milani Deb‐Chatterji received research grants from the Werner Otto Stiftung and University Hospital Schleswig‐Holstein and speaker honoraria from Astra Zeneca (not related to this work). Götz Thomalla reports honoraria as consultant or lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer Ingelheim, BristolMyersSquibb/Pfizer, Stryker, and research grants from the European Union (Horizon 2020), German Research Foundation (DFG), and the German Innovation Fund. Sven Poli reports research support from BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, German Federal Joint Committee Innovation Fund, and German Federal Ministry of Education and Research, Helena Laboratories and Werfen as well as speakers' honoraria/consulting fees from Alexion, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb/Pfizer, Daiichi Sankyo, Portola, and Werfen (not related to this work). Ulf Ziemann received grants from the European Research Council (ERC), German Ministry of Education and Research (BMBF), German Research Foundation (DFG), Else‐Kröner Fresenius Foundation, and consulting fees from CorTec GmbH (not related to this work). Katharina Feil received grants from the University of Tübingen (AKF) and speakers' honoraria/consulting fees from AstraZeneca and BMS/Pfizer (not related to this work).

Figures

FIGURE 1
FIGURE 1
Flowchart of selection process. EVT, endovascular treatment; GSR‐ET, German Stroke Registry—Endovascular Treatment; n, number; NIHSS, National Institutes of Health Stroke Scale; pmRS, pre‐stroke modified Rankin Scale.
FIGURE 2
FIGURE 2
Functional outcome at follow‐up. (A) Unmatched cohort, (B) Cohort 1, (C) Cohort 2. mRS, modified Rankin Scale.
FIGURE 3
FIGURE 3
Predictors of outcome at discharge and follow‐up in multivariable binary logistic regression analyses (unmatched cohort). (A) Predictors of good outcome at discharge and follow‐up. (B) Predictors of excellent outcome at discharge and follow‐up. (C) Predictors of mortality at discharge and follow‐up. IVT, intravenous thrombolysis; NIHSS, National Institutes of Health Stroke Scale; (p)mRS, (premorbid) modified Rankin Scale; sICH, symptomatic intracranial hemorrhage. #Time from symptom onset OR time of recognition of stroke until flow restoration [min]. *Significant.
FIGURE 4
FIGURE 4
Predictors of outcome at discharge and follow‐up in multivariable binary logistic regression analyses (matched cohort 1) and conditional logistic regression (cohort 2). (A) Predictors of good outcome at discharge and follow‐up. (B) Predictors of excellent outcome at discharge and follow‐up. (C) Predictors of mortality at discharge and follow‐up. IVT, intravenous thrombolysis; NIHSS, National Institutes of Health Stroke Scale; (p)mRS, (premorbid) modified Rankin Scale; sICH, symptomatic intracranial hemorrhage. #Time from symptom onset OR time of recognition of stroke until flow restoration [min]. *Significant.
See this image and copyright information in PMC

References

    1. Gall S. L., Donnan G., Dewey H. M., et al., “Sex Differences in Presentation, Severity, and Management of Stroke in a Population‐Based Study,” Neurology 74, no. 12 (2010): 975–981. - PubMed
    1. Grimes K., Mehndiratta P., and Chaturvedi S., “The Impact of Sex on Stroke Care: From Epidemiology to Outcome,” Journal of Stroke and Cerebrovascular Diseases 33 (2024): 107675. - PubMed
    1. Reeves M. J., Bushnell C. D., Howard G., et al., “Sex Differences in Stroke: Epidemiology, Clinical Presentation, Medical Care, and Outcomes,” Lancet Neurology 7, no. 10 (2008): 915–926. - PMC - PubMed
    1. Renedo D., Acosta J. N., Leasure A. C., et al., “Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019,” JAMA Neurology 81 (2024): 394–404. - PMC - PubMed
    1. Peters S. A. E., Carcel C., Millett E. R. C., and Woodward M., “Sex Differences in the Association Between Major Risk Factors and the Risk of Stroke in the UK Biobank Cohort Study,” Neurology 95, no. 20 (2020): e2715–e2726. - PMC - PubMed

Publication types

Associated data