ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicAnatomical Variability, Sex-Based Differences, and Age-Specific Therapies in StrokeView all 3 articles
Sex-Based Differences in Outcomes Following Endovascular Therapy for Anterior Circulation Large Vessel Occlusion: A Pooled Analysis of DEVT, RESCUE BT and MARVEL trials
Provisionally accepted
Lingyu Zhang1*
Yangyang Duan2Jinfu Ma3Xu Xu3Haoxuan Zhu4
Shi Xiaolei3Shihai Yang3Zhixi Wang3Mingyang Chen3Yihui Yang3Yuhan Fan3Binghan Wang3Guojian Liu3Linyu Li3Zhenxuan Tian5Boyu Chen5
Chawen Ding5Dahong Yang3
Wenzhe Sun3
Gaoming Li3Lilan Wang3Shitao Fan3Chengsong Yue3Nizhen Yu3Jie Yang3
Wei Li2Zhuang Li3- 1Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
- 2The First Affiliated Hospital of Hainan Medical University, Haikou, China
- 3Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, China
- 4The 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force, Yichun, China
- 5The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Background: This study sought to characterize sex-specific treatment effects by comparing clinical outcomes between men and women undergoing EVT. Methods: Analyses were based on the DEVT, RESCUE BT and MARVEL databases. Men and women were matched using propensity score matching (PSM). The primary outcome was defined as the 90-day ordinal modified Rankin Scale score (mRS) distribution. Secondary outcomes included favorite outcome (mRS 0 to 3), functional independence (mRS 0 to 2), and excellent outcome (mRS 0 to 1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Results: Of 2862 patients, 1221 (42.7%) were women and 1641(57.3%) were men. After adjusting for covariates, there were no sex differences in 90-day ordinal mRS distribution (median [interquartile range], 3 [1–6] versus 3 [1–5], common Odds Ratio [OR], 1.02 [0.89-1.18], P = 0.741). The secondary outcomes demonstrated consistency with the primary findings, and the safety outcomes remained stable across men and women. After 1:1 PSM, the results remained consistent with the adjusted outcomes described above. Conclusion: This pooled analysis demonstrated no statistically significant differences were observed between men and women in clinical or safety outcomes following EVT for anterior circulation LVO. Furthermore, there was no evidence of interaction between sex and predefined subgroups in terms of treatment effect modification for
Keywords: Acute ischemic stroke, clinical outcome, endovascular treatment, Large vessel occlusion, Sex
Received: 24 Nov 2025; Accepted: 19 Dec 2025.
Copyright: © 2025 Zhang, Duan, Ma, Xu, Zhu, Xiaolei, Yang, Wang, Chen, Yang, Fan, Wang, Liu, Li, Tian, Chen, Ding, Yang, Sun, Li, Wang, Fan, Yue, Yu, Yang, Li and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lingyu Zhang
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