Sex-Related Differences in Endovascular Treatment Outcomes for Acute Large Infarcts: The ANGEL-ASPECT Subanalysis

Dapeng Sun; Xin Guo; Li Ling; Liwen Jiao; Thanh N Nguyen; Mohamad Abdalkader; Yuesong Pan; Mengxing Wang; Gang Luo; Baixue Jia; Xu Tong; Ning Ma; Feng Gao; Dapeng Mo; Raynald; Xiaochuan Huo; Zhongrong Miao; ANGEL-ASPECT Study Group

doi:10.1161/STROKEAHA.124.050025

Sex-Related Differences in Endovascular Treatment Outcomes for Acute Large Infarcts: The ANGEL-ASPECT Subanalysis

Stroke. 2025 May 9. doi: 10.1161/STROKEAHA.124.050025. Online ahead of print.

Authors

Dapeng Sun^#^{1

2}, Xin Guo^#³, Li Ling^#⁴, Liwen Jiao⁵, Thanh N Nguyen⁶, Mohamad Abdalkader⁶, Yuesong Pan^{1

2}, Mengxing Wang², Gang Luo^{1

2}, Baixue Jia^{1

2}, Xu Tong^{1

2}, Ning Ma^{1

2}, Feng Gao^{1

2}, Dapeng Mo^{1

2}, Raynald¹, Xiaochuan Huo⁷, Zhongrong Miao^{1

2}; ANGEL-ASPECT Study Group

Collaborators

Affiliations

¹ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China. (D.S., Y.P., G.L., B.J., X.T., N.M., F.G., D.M., R., Z.M.).
² China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China. (D.S., Y.P., M.W., G.L., B.J., X.T., N.M., F.G., D.M., Z.M.).
³ Department of Neurointervention, Beijing Fengtai You'anmen Hospital, China (X.G.).
⁴ Department of Neurology, Affiliated Hospital of Hebei University, China (L.L.).
⁵ Capital Medical University, Beijing, China (L.J.).
⁶ Department of Neurology, Radiology, Boston Medical Center, MA (T.N.N., M.A.).
⁷ Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, China (X.H.).

^# Contributed equally.

PMID: 40340582
DOI: 10.1161/STROKEAHA.124.050025

Abstract

Background: The outcomes of endovascular therapy (EVT) across sexes for large infarcts remain unclear. This study aimed to evaluate the impact of sex on the outcomes of EVT or medical management for patients with large infarcts.

Methods: In this secondary analysis of the ANGEL-ASPECT (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core) randomized controlled trial conducted at 46 stroke centers across China between October 2, 2020, and May 18, 2022, we compared baseline characteristics and clinical outcomes between males and females, and each cohort further divided into EVT and medical management groups. The primary outcome was the 90-day modified Rankin Scale score distribution. Safety outcomes included symptomatic intracranial hemorrhage within 48 hours and mortality within 90 days.

Results: There were 176 of 455 patients enrolled in the ANGEL-ASPECT trial who were female. There were 54.0% (95/176) of females and 48.4% (135/279) of males who underwent EVT. The treatment effect of EVT did not vary in both sexes with large infarcts (all P>0.05 for interaction). Compared with medical management, EVT improved 90-day functional outcomes for both males (3 [2-5] versus 4 [3-5]; common odds ratio, 1.94 [95% CI, 1.27-2.97]; P=0.002) and females (4 [3-6] versus 5 [4-6]; common odds ratio, 2.50 [95% CI, 1.41-4.45]; P=0.002). The symptomatic intracranial hemorrhage rate was not different in both treatment groups across both sexes (males, 5.2% versus 2.8%; odds ratio, 2.05 [95% CI, 0.56-7.50]; P=0.278; females, 7.4% versus 2.5%; odds ratio, 2.89 [95% CI, 0.55-15.14]; P=0.210).

Conclusions: In patients with large ischemic core, the treatment effect of EVT did not differ between females and males, with better outcomes with EVT versus medical management, without an increased risk of symptomatic intracranial hemorrhage. These findings emphasize the need for equal attention and care for both sexes with large infarcts in clinical practice.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04551664.

Keywords: female; intracranial hemorrhages; male; odds ratio; stroke.

Associated data

ClinicalTrials.gov/NCT04551664