Sex differences in the utilization and outcomes of endovascular treatment after acute ischemic stroke: A systematic review and meta-analysis

Abstract

BackgroundStudies of sex differences in the use and outcomes of endovascular treatment (EVT) for acute ischemic stroke report inconsistent resultsMethodsWe systematically searched PubMed and Embase databases for studies examining sex-specific utilization of EVT for acute ischemic stroke published before 31 December 2021. Estimates were compared by study type: randomized clinical trials (RCTs) and non-RCTs (hospital-based, registry-based or administrative data). Random effects odds ratios (ORs) were generated to quantify sex differences in EVT use. To estimate sex differences in functional outcome on the modified Rankin scale after EVT, the female:male ratio of ORs and 95% confidence intervals (CIs) were obtained from ordinal or binary analysis.Results6,396 studies were identified through database searching, of which 594 qualified for a full review. A total of 51 studies (36 non-RCT and 15 RCTs) reporting on sex-specific utilization of EVT were included, and of those 10 estimated the sex differences of EVT on functional outcomes. EVT use was similar in women and men both in non-RCTs (OR: 1.03, 95% CI: 0.96–1.11) and RCTs (1.02, 95% CI: 0.89–1.16), with consistent results across years of publication and regions of study, except that in Europe EVT treatment was higher in women than men (1.15, 95% CI: 1.13–1.16). No sex differences were found in the functional outcome by either ordinal and binary analyses (ORs 0.95, 95% CI: 0.68–1.32] and 0.90, 95% CI: 0.65–1.25, respectively).ConclusionsNo sex differences in EVT utilization or on functional outcomes were evident after acute ischemic stroke from large-vessel occlusion. Further research may be required to examine sex differences in long-term outcomes, social domains, and quality of life.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226100, identifier: CRD42021226100.

Predictors of functional outcome after stroke: Sex differences in older individuals

“…39 The opposite is true for thrombectomy, from which females benefit more in achieving better functional outcome, although other studies found no notable sex differences in the outcome of stroke after thrombectomy. 47 This study found that in patients aged 80 and older, a higher proportion of stroke patients were females. Females were older at the time of onset and suffered from more severe strokes.…”

“…The authors attributed this to the more flexible dosing of IAT and the higher concentrations of fibrinolytic agent achieved, which could potentially overcome the thrombolytic resistance of females 39 . The opposite is true for thrombectomy, from which females benefit more in achieving better functional outcome, although other studies found no notable sex differences in the outcome of stroke after thrombectomy 47 …”

Sex and gender differences in health and disease. Part II. Clinical and medical-social

“…Несмотря на значительные различия в результатах отдельных исследований, объединенные данные показывают, что женщинам с острым инсультом внутривенный тромболизис назначают реже, чем мужчинам [64]. Недавний систематический обзор в целом не выявил половых различий в частоте использования эндоваскулярной терапии или ее исходах, но с разницей между отдельными странами [65]. Появляющиеся данные свидетельствуют о том, что женщины имеют больше пользы от вмешательства, чем мужчины, но это преимущество используется не в полной мере.…”