Gender Differences in Acute Ischemic Stroke

Abstract

Background and Purpose-Differences between women and men in relation to stroke are increasingly being recognized. Methods-From July 2004 until June 2007, 237 acute ischemic stroke (AIS) patients were treated with recombinant tissue plasminogen activator (rtPA) within 3 hours after onset of symptoms in our stroke unit. Baseline characteristics, etiology, CT/MRI stroke patterns, clinical outcome, and complications of women were compared to those of men. Results-Of 237 AIS patients (mean age 70.7 years), 111 (46.8%) were women and 126 (53.2%) were men. Women were older (Pϭ0.001), but history of hyperlipidemia (Pϭ0.03), smoking (Pϭ0.03), and coronary heart disease (PϽ0.001) was less frequent than in men. Internal carotid artery disease occurred more often in men (Pϭ0.02), whereas atrial fibrillation was observed more often in women (Pϭ0.002). In men borderzone/small embolic and lacunar stroke was found more frequently (39.7 versus 27.2%), whereas women showed a higher percentage of large territorial stroke (72.8 versus 60.3%, Pϭ0.09). Baseline National Institute of Health Stroke Scale scores (12.5 versus 11.3), NIHSS score at discharge (11.0 versus 9.5), 3-month-outcome modified Rankin Scale score, thrombolysis-related (17.1% versus 13.5%) or independent complications (32.4% versus 30.2%), and mortality after 3 months (13.5% versus 9.5%) were similar. Conclusion-Differences of stroke lesion patterns in genders are paralleled by differences in etiology and risk factor profiles (women, cardioembolism; men, large and small vessel disease). Baseline characteristics, rates of rtPA-related and independent complications, as well as clinical outcomes were not different between women and men with AIS.

Does Sex Influence the Response to Intravenous Thrombolysis in Ischemic Stroke?

“…1,[3][4][5] However, the fibrin-rich and smaller volume embolic clots, often observed in cardioembolism, might also be the reason for women to be relatively more prone to recanalization after intravenous thrombolysis and to benefit from the treatment. 17,23 In agreement with this hypothesis, the course of the hyperdense middle cerebral artery sign during follow-up in our series would suggest a relatively more frequent occurrence of arterial recanalization in women compared with men.…”

“…But, at variance with our study, authors did not observe any sex differences for mortality. Results similar to ours were observed in smaller open-label studies on intravenous tPA, [15][16][17][18] as well as in a systematic review of 16 studies on intravenous thrombolysis, which reported no sex-based difference in functional outcome after controlling for the typical baseline imbalances between men and women. 18 Randomized clinical trials on intra-arterial thrombolysis, such as PROACT-2, 8 reached the same conclusion as that of the intravenous thrombolysis randomized clinical trial pooled analysis, 6 with regard to a similar functional outcome between sexes, with a 20% relative benefit in women and 10% in men after treatment with intra-arterial prourokinase when compared with the respective placebo counterparts.…”

Stroke and the Extracranial Carotid Arteries: Role of Color Doppler

“…As is shown in Table 4, no atherosclerotic plaque was found in 26 cases (52%) while carotid stenosis was seen in 24 cases (48%). Male patients were more than female patients and correlated with Forster et and Sethi et al (11,12) . Increased intimo media thickness (IMT) was seen in total 29% of cases out of which 25% were above 60 years of age.…”

White Matter Hyperintensities Predict Low Frequency Hearing in Older Adults

“…These effects are seen in males and females with hypertension, however. In addition, one argument against a female-specific small vessel disease effect on hearing is that men are more likely to experience large and small vessel disease than women (Forster et al 2009). It is important to note that the male participants contributed to the associations observed in this current study but had relatively reduced probability of WMH and low frequency hearing loss.…”