Stroke Thrombectomy Utilization Rates by Sex: What were Things Like before 2015?

Abstract

Background: Little is known about any potential sex disparities in access to mechanical thrombectomy (MT), including before the pivotal clinical trials establishing MT as a standard of care for acute ischemic stroke management. Methods: All ischemic stroke patients included in the National Inpatient Sample between 2006 and 2014, were identified using the international classification of disease, Ninth Revision, Clinical Modification 433.X1, 434.X1, and 436. Those who received MT were identified using the procedure code 39.74. We computed the rate and trend in MT utilization among stroke patient by sex. We also applied a logistic regression model to examine the association between sex and the rate of MT, accounting for potential extraneous confounders. Results: Of the 520,963 (weighted 1,032,940) with ischemic stroke, 6049 (.59%) received mechanical thrombectomy (MT), including 3012 (.58%) women and 3037 (.60%) men (P = .2807). For both men and women the rate of MT increased by nearly 30-fold from .04% in 2006 to 1.13% in 2014. On univariate analysis there was no difference in annual change in the utilization of MT; however, after adjusting for confounders, women with ischemic stroke were 12% more likely to have received treatment with MT than their male counterparts. Conclusion: The rate of MT has increased in both genders by nearly 30-fold in the 9 years preceding the publication of pivotal clinical trials on MT in 2015 with a 12% higher likelihood for women to receive MT after ischemic stroke.