TOPLINE:

Women with acute ischaemic stroke had a significantly longer door-to-needle time and higher in-hospital mortality rates than men in the emergency department (ED), although both had a similar likelihood of access to revascularisation treatments.

METHODOLOGY:

• Researchers in Italy conducted an observational study to evaluate sex-based differences in access to revascularisation treatments among patients with acute ischaemic stroke.
• They included 9167 patients (median age, 75 years; 49% women) who were admitted to the ED with suspected stroke between January 2015 and December 2022.
• Of these, 4070 had acute ischaemic stroke, 882 had transient ischaemic attack, 607 had intracerebral haemorrhage, and 3608 experienced stroke mimics.
• Among patients who underwent revascularisation treatments, several stroke care time metrics such as door-to-CT scan time, door-to-needle time, and door-to-groin time were collected.
• The primary outcome was access to revascularisation treatments for acute ischaemic stroke, and secondary outcomes included intravenous thrombolysis (IVT), endovascular treatment (EVT), stroke care time metrics, and in-hospital mortality.

TAKEAWAY:

• Overall, 22.9% of patients received revascularisation treatments, of whom 15.8% received IVT and 11.4% received EVT. No significant difference was observed between men and women in terms of the likelihood of receiving IVT and EVT.
• Women showed a 4-minute longer door-to-needle time than men (54 vs 50 minutes; P = .030), with no significant differences observed in door-to-CT scan time and door-to-groin time.
• In-hospital mortality rates were significantly higher in women than in men (13.1% vs 10.5%; P = .010). Men experienced shorter ED stays and a significantly higher rate of admission to the neurology ward than women (P < .05 for both).
• Male sex was an independent predictor of lower door-to-needle time (P = .025); however, no significant sex-related effect was observed on door-to-CT scan time and door-to-groin time.

IN PRACTICE:

"[The study] findings may reflect growing awareness of sex disparities in healthcare, coupled with the rising incidence of stroke among women, which may have facilitated stroke recognition and is progressively narrowing historical gaps in access to RTs [revascularisation treatments]," the authors wrote.

SOURCE:

This study was led by Irene Scala, Clinical Neuroscience Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. It was published online on May 11, 2026, in European Stroke Journal.

LIMITATIONS:

The single-centre nature limited the generalisability of the findings to smaller hospitals. The retrospective design may have influenced statistical analyses and restricted causal associations. The use of categorical onset-to-door times rather than continuous measures may have limited the ability to detect sex-based differences in prehospital time metrics.

DISCLOSURES:

This study did not disclose any funding. The authors declared having no conflicts of interest. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.