Age-Dependent Susceptibility to Infarct Growth in Women

Abstract

Background and Purpose-It is not known if there is a relationship between gender and tissue outcome in human ischemic stroke. We sought to identify whether the proportion of initially ischemic to eventually infarcted tissue was different between men and women with ischemic stroke. Methods-We studied 141 consecutive patients with acute ischemic stroke who had a baseline MRI obtained within 12 hours of symptom onset, a follow-up imaging on Day 4 or later, and diffusion-weighted imaging/mean transmit time mismatch on initial MRI. Lesion growth was calculated as percentage of mismatch tissue that underwent infarction on follow-up (percentage mismatch lost). Multivariable analyses explored the effect of gender and other predictors of tissue outcome on percentage mismatch lost. Results-There was no difference in median percentage mismatch lost between men (19%) and women (11%; Pϭ0.720). There was, however, an interaction between gender and age; median percentage mismatch lost was 7% (0% to 12%) in women and 18% (1% to 35%) in men younger than the population median (71 years, Pϭ0.061). The percentage mismatch lost was not different between men and women Ն71 years old (25% in both groups). The linear regression model revealed gender (Pϭ0.027) and the interaction between age and gender (Pϭ0.023) as independent predictors of percentage mismatch lost. Conclusions-There is an age-by-gender interaction in tissue outcome after ischemic stroke; brain infarcts in women Ͻ70years grow approximately 50% less than infarcts in their male counterparts. These findings extend the well-known concept that there is a differential age-by-gender effect on stroke incidence, mortality, and functional outcome to the tissue level. (Stroke. 2011;42:947-951.)

Interaction of age with the ischaemic penumbra, leptomeningeal collateral circulation and haemodynamic variables in acute stroke: a pilot study

“…Previous work using perfusion–diffusion MRI, within 12 h of stroke onset, has suggested that age is a predictor of loss of penumbral tissue to the final infarction 8 9. Although in these studies the penumbra was defined visually without the use of quantitative thresholds, which may be prone to errors,31 our data point to a differential early response that may progress along the distinct trajectory they illustrate.…”

“…While animal models have substantiated the view that tissue response may be distinct with increasing age,6 7 studying this issue in the clinical setting is difficult and has been rarely addressed. Previous work using perfusion–diffusion MRI has suggested that age is a predictor of conversion of penumbral tissue to the final infarction 8 9. These important studies, however, do not describe ischaemic tissue characteristics with concomitant vascular and haemodynamic changes within the acute phase.…”

Leukoaraiosis and Sex Predict the Hyperacute Ischemic Core Volume

“…Key factors associated with acute ischemic core expansion include the time from symptom onset, 4 collateral status, 6 and site of arterial occlusion. There is mounting evidence that sex and extent of leukoaraiosis (LA) may significantly alter cerebrovascular reserve, 7–10 which translates to greater infarct growth in animal stroke models. 11,12 Only two respective MRI-based volumetric analyses reported that sex 7 and LA 9 were associated with the expansion of the acute ischemic lesion.…”

“…There is mounting evidence that sex and extent of leukoaraiosis (LA) may significantly alter cerebrovascular reserve, 7–10 which translates to greater infarct growth in animal stroke models. 11,12 Only two respective MRI-based volumetric analyses reported that sex 7 and LA 9 were associated with the expansion of the acute ischemic lesion. However, the potential contribution of collaterals and site of arterial occlusion location was not reported.…”

Age-related metabolic disturbances in adult patients with acute ischemic stroke

“…The investigation of 141 consecutive AIS patients reveals an interaction between gender and age (17). The median percentage mismatch lost is 7% (0% to 12%) in women and 18% (1% to 35%) in men younger than the population median (71 years, p=0.061).…”