Journal article
Sex-Based Differences in Endovascular Thrombectomy Outcomes for Large Ischemic Stroke: A SELECT2 Subanalysis
Stroke (1970), Vol.56(2), pp.294-304
02/2025
DOI: 10.1161/STROKEAHA.124.049307
PMID: 39744837
Abstract
Several social and biological factors are shown to differentially affect stroke outcomes between men and women. We evaluated whether clinical outcomes and endovascular thrombectomy (EVT) treatment effects differed between the sexes in patients presenting with large ischemic stroke.
The SELECT2 trial (A Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke) was a randomized controlled trial assessing the efficacy and safety of EVT in patients with large strokes across the United States, Canada, Europe, Australia, and New Zealand between October 2019 and September 2022. In this subanalysis, baseline characteristics and clinical and imaging outcomes were compared between women and men, each further divided into cohorts receiving medical treatment without and with EVT. Functional outcomes at 90-day and 1-year follow-ups were assessed using regression models, adjusting for potential confounders. Sex-related effect modification was examined.
Women accounted for 145 (41%) of 352 patients enrolled in the SELECT2 trial. Seventy-one (49%) of 145 women and 109 (53%) of 207 men underwent EVT. Endovascular intervention was associated with better functional outcomes (women: adjusted generalized odds ratio, 1.73 [1.22-2.45]; men: adjusted generalized odds ratio, 1.66 [1.24-2.23];
-int: 0.94), functional independence (women: EVT, 20% versus medical management, 4%; adjusted risk ratio [aRR], 5.04 [1.59-16.02]; men: EVT, 20% versus medical management, 9%; aRR, 1.99 [0.99-4.02];
-int: 0.20), and independent ambulation (women: EVT, 39% versus medical management, 16%; aRR, 2.44 [1.40-4.24]; men: EVT, 38% versus medical management, 20%; aRR, 1.98 [1.29-3.03];
-int: 0.67) in both men and women at 90-day follow-up, without significant heterogeneity. Similar results were observed at 1-year follow-up. In women, as age increased (aRR, 0.97 [95% CI, 0.95-0.99];
=0.004 per year) and core volume estimates increased (aRR, 0.99 [95% CI, 0.98-1.00];
=0.015 per mL increase), the rate of independent ambulation after EVT decreased. A similar association of age and core volume was seen in men.
EVT treatment benefit was maintained in both women and men, with higher rates of functional independence and independent ambulation as compared with medical management. Age and estimated core infarct volume were independently associated with independent ambulation in both male and female patients. EVT should be equally considered for patients of both sexes meeting large core eligibility criteria.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03876457.
Details
- Title: Subtitle
- Sex-Based Differences in Endovascular Thrombectomy Outcomes for Large Ischemic Stroke: A SELECT2 Subanalysis
- Creators
- Jenny P Tsai - Cleveland ClinicThanh N Nguyen - Boston Medical CenterDeep K Pujara - Case Western Reserve UniversityJohanna T Fifi - Icahn School of Medicine at Mount SinaiSophia Sundararajan - Case Western Reserve UniversityJoanna D Schaafsma - Toronto Western HospitalNatalia Pérez de la Ossa - Hospital Universitari Germans Trias i PujolMichael G Abraham - University of Kansas Medical CenterMichael Chen - Rush University Medical CenterMuhammad S Hussain - Cleveland ClinicSantiago Ortega-Gutierrez - University of Iowa Hospitals and ClinicsHannah T Johns - The Royal Melbourne HospitalKelsey R Duncan - Case Western Reserve UniversityLeonid Churilov - The Royal Melbourne HospitalColleen G Lechtenberg - University of Kansas Medical CenterSabreena J Slavin - University of Kansas Medical CenterAmanda Opaskar - Case Western Reserve UniversityMercedes de Lera - Hospital Clínico Universitario de ValladolidBlanca Lara-Rodriguez - Bellvitge University HospitalHelena Quesada - Bellvitge University HospitalLauren E Fournier - Baylor Scott & White Medical Center - TempleDana M Defta - Case Western Reserve UniversityFaris Shaker - University of Kansas Medical CenterClark W Sitton - The University of Texas Health Science Center at HoustonAnjail Z Sharrief - The University of Texas Health Science Center at HoustonJames C Grotta - Memorial HermannMichael D Hill - University of CalgaryMarc Ribo - Vall d'Hebron Hospital UniversitariAmeer E Hassan - Valley Baptist Medical CenterBruce C V Campbell - The Royal Melbourne HospitalCathy Sila - Case Western Reserve UniversityStavropoula I Tjoumakaris - Thomas Jefferson University HospitalAmrou Sarraj - Case Western Reserve UniversitySELECT2 Investigators
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.56(2), pp.294-304
- DOI
- 10.1161/STROKEAHA.124.049307
- PMID
- 39744837
- NLM abbreviation
- Stroke
- ISSN
- 1524-4628
- eISSN
- 1524-4628
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Grant note
- Stryker Neurovascular
The SELECT2 trial (A Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke) was funded by Stryker Neurovascular through an institutional grant to UT McGovern Medical School and UH Cleveland Medical Center. This secondary analysis received no funding. The funder did not have any role in the design, execution, data collection, monitoring, analysis, article drafting, revision, or decision to publish.
- Language
- English
- Electronic publication date
- 01/02/2025
- Date published
- 02/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984769616002771
Metrics
20 Record Views