Are There Sex Differences in Thrombectomy Utilisation in Treatment of Acute Ischaemic Stroke? A Systematic Review and meta-analysis

Objectives Mechanical thrombectomy (MT) is a highly effective treatment for acute ischaemic stroke (AIS). Our aim was to determine whether there are differences in access to thrombectomy between men and women; this is an important question because a previous meta-analysis had shown that women were less likely than men to receive intravenous thrombolysis for AIS. Materials This was a systematic review and meta-analysis. Methods Medical databases (Embase, Medline and APA Web of Science) were searched for eligible studies from 01/01/2010-30/09/2021. Two independent authors screened titles and abstracts and scrutinised full texts. Eligible studies were hospital-based, registry-based, or administrative data studies reporting sex-specific data on patients treated with thrombectomy for AIS, in representative populations of patients with AIS. Studies including only posterior circulation strokes were excluded. Summary unadjusted odds ratios were calculated to compare MT utilisation in men and women. Results 1,379 citations were retrieved, 76 underwent full review and 16 were included in the meta-analysis, which comprised 5,281,009 stroke cases (47.2% women, 52.8% men). The summary unadjusted OR for sex differences in thrombectomy use was 0.931 (95% CI 0.834-1.040, p=0.206), indicating women had lower odds of receiving MT though confidence intervals overlapped one. There was statistically significant heterogeneity between studies (Q=1043.13 p<0.0001, I 2 =98.56%). Conclusion We found no clear evidence that women were less likely to receive thrombectomy then men. Future studies should continue to report sex-specific data to ensure that there is equity of access to thrombectomy irrespective of sex.