Is the effect of sex on post-thrombectomy outcomes in acute ischemic stroke age-dependent? Results from an international prospective registry (EVA-TRISP)

We aimed to investigate the effect of sex on clinical outcomes after endovascular treatment (EVT) in ischemic stroke patients and whether this effect is age dependent. We used data from EVA-TRISP, a multicentre registry of consecutive EVT patients. Primary outcome was the 90-day modified Rankin Scale (mRS) score, analysed with unadjusted and adjusted mixed model ordinal regression. We compared women with men and assessed the interaction between age and sex. We assessed age both as a continuous variable and dichotomized at the population median. In total, 12,915 EVT patients were included for the current study (median age 74 [IQR 64–82] years, 6,251 [48.4%] women). Female patients were older (77 [IQR 67–84] vs 72 [IQR: 62–80], p < 0.001) and had a higher median baseline NIHSS (15 [IQR 9–19] vs 14 [IQR 8–19], p < 0.001). Female sex was associated with worse functional outcome in the unadjusted analysis (cOR 1.22, 95%CI:1.14–1.29) but not in the adjusted analysis (acOR 1.02, 95%CI:0.95–1.09). We found no significant interaction between age and sex when assessing age as a continuous variable ( p = 0.08), but observed a significant interaction when dichotomizing age ( p = 0.01). In patients aged 74 or younger, women had worse outcomes than men (acOR 1.10, 95%CI:1.003–1.20) while sex was not associated with functional outcome in older patients (acOR 0.93, 95%CI:0.85–1.02). We did not find clear evidence that the effect of sex on post-EVT outcomes is modified by age when using age as continuous variable, but observed a worse outcome in women in patients aged 74 or younger.

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Journal
BMC Neurology
Published
2026-08-18
DOI
https://doi.org/10.1186/s12883-026-05210-y
Primary Topic
Acute Ischemic Stroke Management
Type
article
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article

Is the effect of sex on post-thrombectomy outcomes in acute ischemic stroke age-dependent? Results from an international prospective registry (EVA-TRISP)

Alex Brehm, Lotte J. Stolze, Valerian Altersberger, Miguel Serôdio et al.
BMC Neurology
Acute Ischemic Stroke Management
article

Is the effect of sex on post-thrombectomy outcomes in acute ischemic stroke age-dependent? Results from an international prospective registry (EVA-TRISP)

Alex Brehm, Lotte J. Stolze, Valerian Altersberger, Miguel Serôdio, Andrea Zini, Rosario Pascarella, Roza M. Umarova, Marcel Arnold, Marialuisa Zedde, E. I. Piechowiak, Mauro Magoni, Luca Frediani, C. Cereda, Tamer Jubeh, Stefano Forlivesi, Dikran Mardighian, Regina von Rennenberg, Alessandro Pezzini, Leon A. Rinkel, Laura Mannismäki, Johanna M. Ospel, for the EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients (EVA-TRISP) investigators, Giovanni Bianco, Simon Truessel, Paul J. Nederkoorn, Nabila Wali, Christian H. Nolte, Nicolas Martinez-Majander, Visnja Padjen, Ivana Berisavac, Anne van der Meij, João Pedro Marto, Ronen R. Leker, Susanne Wegener, Miguel Miranda, Matteo Paolucci, Patrik Michel, Mirjam R. Heldner, Sami Curtze, Stefan T. Engelter, Tomas Dobrocky, Henrik Gensicke, Georg Kägi, Christoph Riegler
article en

Abstract

We aimed to investigate the effect of sex on clinical outcomes after endovascular treatment (EVT) in ischemic stroke patients and whether this effect is age dependent. We used data from EVA-TRISP, a multicentre registry of consecutive EVT patients. Primary outcome was the 90-day modified Rankin Scale (mRS) score, analysed with unadjusted and adjusted mixed model ordinal regression. We compared women with men and assessed the interaction between age and sex. We assessed age both as a continuous variable and dichotomized at the population median. In total, 12,915 EVT patients were included for the current study (median age 74 [IQR 64–82] years, 6,251 [48.4%] women). Female patients were older (77 [IQR 67–84] vs 72 [IQR: 62–80], p < 0.001) and had a higher median baseline NIHSS (15 [IQR 9–19] vs 14 [IQR 8–19], p < 0.001). Female sex was associated with worse functional outcome in the unadjusted analysis (cOR 1.22, 95%CI:1.14–1.29) but not in the adjusted analysis (acOR 1.02, 95%CI:0.95–1.09). We found no significant interaction between age and sex when assessing age as a continuous variable ( p = 0.08), but observed a significant interaction when dichotomizing age ( p = 0.01). In patients aged 74 or younger, women had worse outcomes than men (acOR 1.10, 95%CI:1.003–1.20) while sex was not associated with functional outcome in older patients (acOR 0.93, 95%CI:0.85–1.02). We did not find clear evidence that the effect of sex on post-EVT outcomes is modified by age when using age as continuous variable, but observed a worse outcome in women in patients aged 74 or younger.

BMC Neurology
University of Bern (CH), University of Helsinki (FI), University of Calgary (CA), University of Basel (CH), University of Zurich (CH), Kantonsspital St. Gallen (CH), Hadassah Medical Center (IL), Helsinki University Hospital (FI), University Hospital of Bern (CH), Foothills Medical Centre (CA), University Hospital of Basel (CH), Humboldt-Universität zu Berlin (DE), University of Belgrade (RS), Laboratory for Biomedical Neurosciences (CH), Azienda Unita' Sanitaria Locale Di Modena (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), University Hospital of Zurich (CH), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Hospital de Egas Moniz (PT), Felix Platter-Hospital (CH), Istituto delle Scienze Neurologiche di Bologna (IT), Charité - Universitätsmedizin Berlin (DE), University of Amsterdam (NL), University of Lausanne (CH)
Openalex Percentile: Top 9%
Acute Ischemic Stroke Management
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