Abstract Number: Esoc2026a955 Sex Differences in Stroke Prognosis Across Reperfusion Strategies: Implications for Prevention and Quality of Life

Abstract Background and aims Sex-specific trajectories of vascular ageing may influence stroke recovery, yet their impact on reperfusion therapy outcomes remains uncertain. We examined sex differences in the access to acute stroke care, functional outcomes, and survival after large vessel occlusion stroke. Methods We analysed 3,760 consecutive patients with angiography-confirmed cerebral vessel occlusion transferred for endovascular therapy (EVT) between 2015 and 2022. Baseline characteristics, workflow metrics, reperfusion success, complications, functional outcome, and 12-month survival were compared between sexes. Propensity score matching (1:1) for age and baseline NIHSS was performed. Survival was assessed using Kaplan–Meier analysis and multivariable Cox regression. Results Women comprised 45.1% of patients and were older (median 77 vs. 70 years) with higher baseline NIHSS scores (14 vs. 12; p 0.001). Access to guideline-recommended acute stroke care was equivalent across sexes, including intravenous thrombolysis, EVT rates, workflow intervals, and successful reperfusion (TICI 2b–3). In the full cohort, 12-month survival did not differ (log-rank p = 0.38). After matching (1,302 pairs), women had superior 12-month survival (log-rank p 0.0001). Among EVT-treated patients (n = 2,795), functional independence at 90 days was similar (mRS 0–2: 47.8% women vs. 49.2% men; p = 0.58), while women had fewer PH2 haemorrhages (3.1% vs. 4.9%; p = 0.016). Female sex independently predicted lower 12-month mortality (HR 0.78, 95% CI 0.69–0.89). Conclusions Women had equal access to reperfusion therapies with comparable outcomes. Female sex was independently associated with improved long-term survival, suggesting sex-specific resilience to long term complications of stroke. Conflict of interest The authors have nothing to disclose.