Do Outcomes between Women and Men Differ after Endovascular Thrombectomy? A Meta-analysis

BACKGROUND: Research on the presence of sex-based differences in the outcomes of patients undergoing endovascular thrombectomy for acute ischemic stroke has reached differing conclusions.

PURPOSE: This review aimed to determine whether sex influences the outcome of patients with large-vessel occlusion stroke undergoing endovascular thrombectomy.

STUDY SELECTION: We performed a systematic review and meta-analysis of endovascular thrombectomy studies with either stratified cohort outcomes according to sex (females versus males) or effect size reported for the consequence of sex versus outcomes. We included 33 articles with 7335 patients.

DATA ANALYSIS: We pooled ORs for the 90-day mRS score, 90-day mortality, symptomatic intracranial hemorrhage, and recanalization.

DATA SYNTHESIS: Pooled 90-day good outcomes (mRS ≤ 2) were better for men than women (OR = 1.29; 95% CI, 1.09–1.53; P = <.001, I² = 56.95%). The odds of the other outcomes, recanalization (OR = 0.94; 95% CI, 0.77–1.15; P = .38, I² = 0%), 90-day mortality (OR = 1.11; 95% CI, 0.89–1.38; P = .093, I² = 0%), and symptomatic intracranial hemorrhage (OR = 1.40; 95% CI, 0.99–1.99; P = .069, I² = 0%) were comparable between men and women.

LIMITATIONS: Moderate heterogeneity was found. Most studies included were retrospective in nature. In addition, the randomized trials included were not specifically designed to compare outcomes between sexes.

CONCLUSIONS: Women undergoing endovascular thrombectomy for large-vessel occlusion have inferior 90-day clinical outcomes. Sex-specific outcomes should be investigated further in future trials as well as pathophysiologic studies.