Abstract TP003: Standardized Protocols Achieve Sex-Neurtral Outcomes in Acute stroke Care

Introduction: Sex-based disparities in acute stroke care have been well documented, with women experiencing longer treatment delays and worse outcomes compared to men. Reported inequities include longer door-to-needle (DTN) and door-to-puncture (DTP) times as well as reduced referral to comprehensive stroke centers. To evaluate whether such disparities persist within our system, we assessed workflow and clinical outcomes at a comprehensive stroke center operating under standardized protocols, including automatic acceptance for thrombectomy (EVT) in patients with ASPECTS ≥3 and acute symptoms. Methods: We retrospectively reviewed consecutive acute ischemic stroke patients treated with thrombolysis (IVT) and/or EVT between January 2024 and May 2025. Patients were stratified by sex. Workflow outcomes included door-to-CT, door-to-stroke-alert, DTN, and DTP times. Clinical outcomes included reperfusion success (TICI ≥2B), hemorrhagic conversion, and functional status by mRS at discharge and 90 days. Results: A total of 204 patients (46% women) were included. Baseline demographics were comparable except for higher median NIHSS in women (12 vs 9). Reperfusion therapies were used at similar rates across sexes. No sex-based differences were observed in workflow metrics: door-to-CT (p=0.73), door-to-alert (p=0.82), DTN (p=0.33), and DTP (p=0.72). Clinical outcomes were also similar: successful reperfusion (51.3% men vs 55.6% women, p=0.60), hemorrhagic conversion (3.8% vs 3.3%, p=1.0), mean discharge mRS (3.24 vs 3.51, p=0.30), and 90-day mRS (2.45 vs 2.55, p=0.09). Conclusion: In this single-center cohort, no sex-based disparities in acute stroke treatment were observed. Despite higher baseline stroke severity in women, workflow times, reperfusion success, complication rates, and functional outcomes were equivalent between sexes. Reporting these findings is critical as they counter historical evidence of inequities and demonstrate that standardized protocols and rapid-response systems can achieve equitable, sex-neutral care. Validation in larger multi-center cohorts is needed to confirm generalizability and identify which system-level practices most effectively close disparity gaps.