Background: Randomized trials have shown that mechanical thrombectomy improves 3-month disability outcomes after acute ischemic stroke for both women and men. However post-stroke disability and reduced life expectancy (LE) persists beyond 3 months, and lifetime effects of thrombectomy might differ between men and women.
Methods: We analyzed patients treated with the Solitaire stent retriever in the TripleS database (pooled patient-level data from the SWIFT, STAR, and SWIFT-PRIME trials). Years of optimum life after thrombectomy were defined as disability adjusted life-year (DALYs), using the methodology of the World Health Organization Global Burden of Disease Project. For each patient, LE was calculated based on age and sex-specific values, and known degree of modification of LE by modified Rankin Scale (mRS) status at 3 months post-stroke. Years of optimum life lost due to disability were calculated by projecting mRS status at 3 months through the remaining LE.
Results: Among 389 patients treated with ET, 55% were female, and median NIHSS was 17 [8-28]. There were no differences between females vs. males in presenting deficit severity (NIHSS 17 vs. 17, p=0.21), occlusion location (69% vs. 64% M1, p=0.62), presenting infarct extent (ASPECTS 9 vs. 8, p=0.24), rate of substantial reperfusion (TICI 2b/3, 87% vs. 83%, p=0.37), onset to reperfusion time (277 vs. 306 mins, p=0.46). Women presented at advanced mean age compared to men (69 vs 64, p<0.001). Rates of functional independence at 90 days (53% vs. 56%, p=0.54) were similar in men and women. Without adjusting for age at presentation, years of optimal life (DALYs) following thrombectomy were similar between women and men (9.3 vs 9.6 years, p=0.48). After adjusting for differing ages at presentation, women had more years of optimal life (DALYs) following thrombectomy, 10.6 vs 8.5 years (p<0.001).
Conclusions: In age-standardized comparisons, women experience two more optimal years than men following mechanical thrombectomy for acute ischemic stroke. Greater life expectancies of women, coupled with similar disability outcome distributions, yield substantially greater years of optimal life after intervention.