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Comer AR, Jawed A, Roeder H, Kramer N. The impact of sex and gender on advanced stroke interventions and end-of-life outcomes after stroke. J Stroke Cerebrovasc Dis 2024; 33:107820. [PMID: 38876458 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVES In this review, we examine the impact of sex and gender on advanced stroke interventions and end-of-life outcomes after stroke and discuss the current theories, available evidence, and gaps in the literature. METHODS A scoping review of the literature was conducted to determine gender differences on advanced stroke interventions and end-of-life outcomes after stroke. The study team utilized PubMed to conduct a review of the literature and included research studies related to sex, gender, advanced stroke interventions, and end-of-life outcomes after stroke. The PRISMA process for conducting a scoping review was followed. RESULTS This review found that although evidence regarding gender differences in advanced stroke interventions and end-of-life care after stroke is disparate, some gender differences do indeed exist. Women are less likely to receive thrombectomy or alteplase, women are more likely to receive palliative care intervention, hospice, and women experience stroke mortality at higher rates. CONCLUSIONS Gender differences in end-of-life care after stroke are apparent with women experiencing lower rates of life sustaining interventions, and higher rates of mortality, palliative and hospice care. More research is needed to identify variables associated with or responsible for gender differences during advance interventions and end-of-life care after stroke.
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Affiliation(s)
- Amber R Comer
- American Medical Association, Indiana University, United States.
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Kabangu JLK, Newsome-Cuby T, Hernandez A, Joseph B, Dugan J, Fowler D, Bah MG, Fry L, Eden SV. The Role of County-Level Persistent Poverty in Stroke Mortality in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01981-7. [PMID: 38528179 DOI: 10.1007/s40615-024-01981-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
Stroke is a major health concern in the USA, disproportionately affecting socioeconomically disadvantaged groups. This study investigates the link between persistent poverty and stroke mortality rates in residents aged 65 and above, positing that sustained economic challenges at the county level correlate with an increase in stroke-related deaths. Persistent poverty refers to a long-term state where a significant portion of a population lives below the poverty threshold for an extended period, typically measured over several decades. It captures the chronic nature of economic hardship faced by a community across multiple generations. Utilizing data from the CDC Wonder database and the American Community Survey, we conducted a comprehensive analysis across US counties, differentiating them by persistent poverty status. Our results indicate a statistically significant link between persistent poverty and increased mortality from ischemic and hemorrhagic strokes; counties afflicted by long-standing poverty were associated with an additional 33.49 ischemic and 8.16 hemorrhagic stroke deaths per 100,000 residents annually compared to their wealthier counterparts. These disparities persisted when controlling for known stroke risk factors and other socioeconomic variables. These results highlight the need for targeted public health strategies and interventions to address the disparities in stroke mortality rates and the broader implications for healthcare equity. The study underscores the vital role of socioeconomic context in health outcomes and the urgency of addressing long-term poverty as a key determinant of public health.
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Affiliation(s)
- Jean-Luc K Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS, Kansas City, KS, 3021, USA.
| | - Takara Newsome-Cuby
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | | | - Benson Joseph
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - John Dugan
- University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Danny Fowler
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, USA
| | - Momodou G Bah
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Sonia V Eden
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, TN, USA
- University of Tennessee Health Sciences Center, Memphis, TN, USA
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Abdalkader M, Ning S, Qureshi MM, Haussen DC, Strbian D, Nagel S, Demeestere J, Puetz V, Mohammaden MH, Olive Gadea M, Winzer S, Yamagami H, Tanaka K, Marto JP, Tomppo L, Henon H, Sheth SA, Ortega-Gutierrez S, Martinez-Majander N, Caparros F, Lemmens R, Dusart A, Bellante F, Zaidi SF, Siegler JE, Nannoni S, Kaesmacher J, Dobrocky T, Farooqui M, Salazar-Marioni S, Virtanen P, Vandewalle L, Wouters A, Jesser J, Ventura R, Castonguay AC, Uchida K, Puri AS, Masoud HE, Klein P, Mansoor Z, Bui J, Kang M, Mujanovic A, Rizzo F, Kokkonen T, Ramos JN, Strambo D, Michel P, Möhlenbruch MA, Lin E, Kaiser DPO, Yoshimura S, Sakai N, Cordonnier C, Ringleb PA, Roy D, Zaidat OO, Fischer U, Ribo M, Raymond J, Nogueira RG, Nguyen TN. Sex Differences in Outcomes of Late-Window Endovascular Stroke Therapy. Stroke 2024; 55:278-287. [PMID: 38252759 DOI: 10.1161/strokeaha.123.045015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The association between sex and outcome after endovascular thrombectomy of acute ischemic stroke is unclear. The aim of this study was to compare the clinical and safety outcomes between men and women treated with endovascular thrombectomy in the late 6-to-24-hour window period. METHODS This multicenter, retrospective observational cohort study included consecutive patients who underwent endovascular thrombectomy of anterior circulation stroke in the late window from 66 clinical sites in 10 countries from January 2014 to May 2022. The primary outcome was the 90-day ordinal modified Rankin Scale score. Secondary outcomes included 90-day functional independence (FI), return of Rankin (RoR) to prestroke baseline, FI or RoR, symptomatic intracranial hemorrhage, and mortality. Multivariable and inverse probability of treatment weighting methods were used. We explored the interaction of sex with baseline characteristics on the outcomes ordinal modified Rankin Scale and FI or RoR. RESULTS Of 1932 patients, 1055 were women and 877 were men. Women were older (77 versus 69 years), had higher rates of atrial fibrillation, hypertension, and greater prestroke disability, but there was no difference in baseline National Institutes of Health Stroke Scale score. Inverse probability of treatment weighting analysis showed no difference between women and men in ordinal modified Rankin Scale (odds ratio, 0.98 [95% CI, 0.79-1.21]), FI or RoR (odds ratio, 0.98 [95% CI, 0.78-1.22]), severe disability or mortality (odds ratio, 0.99 [95% CI, 0.80-1.23]). The multivariable analysis of the above end points was concordant. There were no interactions between baseline characteristics and sex on the outcomes of ordinal modified Rankin Scale and FI or RoR. CONCLUSIONS In late presenting patients with anterior circulation stroke treated with endovascular thrombectomy in the 6 to 24-hour window, there was no difference in clinical or safety outcomes between men and women.
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Affiliation(s)
- Mohamad Abdalkader
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Shen Ning
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Muhammad M Qureshi
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Radiation Oncology (M.M.Q.), Boston Medical Center
| | - Diogo C Haussen
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
| | - Daniel Strbian
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Germany (S. Nagel)
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Jelle Demeestere
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Volker Puetz
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | | | - Marta Olive Gadea
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Simon Winzer
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Hiroshi Yamagami
- Department of Stroke Neurology, NHO Osaka National Hospital, Japan (H.Y.)
| | - Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - João Pedro Marto
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Liisa Tomppo
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Hilde Henon
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Sunil A Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston (S.A.S., S.S.-M.)
| | | | | | - Francois Caparros
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Robin Lemmens
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Syed F Zaidi
- Department of Neurology, University of Toledo, Toledo (S.F.Z., A.C.C.)
| | | | - Stefania Nannoni
- Clinical Neurosciences, University of Cambridge, United Kingdom (S. Nannoni)
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | | | | | - Pekka Virtanen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - Lieselotte Vandewalle
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anke Wouters
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Jessica Jesser
- Radiology (J.J., M.A.M.). Heidelberg University Hospital, Germany
| | - Rita Ventura
- Departments of Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | | | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Ajit S Puri
- Interventional Neuroradiology, University of Massachusetts Memorial Medical Center (A.S.P.)
| | - Hesham E Masoud
- Department of Neurology, State University of New York (H.E.M.)
| | - Piers Klein
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Zain Mansoor
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Jenny Bui
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Matthew Kang
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Adnan Mujanovic
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Federica Rizzo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Tatu Kokkonen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - João Nuno Ramos
- Radiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | - Davide Strambo
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | | | - Eugene Lin
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Daniel P O Kaiser
- Institute of Neuroradiology (D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Nobuyuki Sakai
- Neurovascular Research, Kobe City Medical Center General Hospital, Japan (N.S.)
| | - Charlotte Cordonnier
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Peter A Ringleb
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Daniel Roy
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, Switzerland (U.F.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Jean Raymond
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Raul G Nogueira
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
- Department of Neurology, University of Pittsburgh Medical Center (R.G.N.)
| | - Thanh N Nguyen
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Neurology (T.N.N.), Boston Medical Center
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Šaňák D, Gurková E, Štureková L, Šaňáková Š, Zapletalová J, Franc D, Bartoníčková D. Quality of Life in Patients with Excellent 3-Month Clinical Outcome after First-Ever Ischemic Stroke: A Time to Redefine Excellent Outcome? Eur Neurol 2024; 87:1-10. [PMID: 38232714 DOI: 10.1159/000535685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/03/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS. METHODS We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0-1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex. RESULTS In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain "emotion," "strength," and "participation." Patients with NIHSS ≥1 had lower scores in all SIS domains except "emotions" and "mobility." Patients ≥50 years had lower score in "mobility" (p = 0.004) and females in domain of "social participation" (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL. DISCUSSION/CONCLUSIONS Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected "mobility" and females "social participation."
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Affiliation(s)
- Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Lenka Štureková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Šárka Šaňáková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Jana Zapletalová
- Department Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - David Franc
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
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Thompson ED, Miller AE, Reisman DS. Characterizing the impact of multiple chronic conditions on return to participation in chronic stroke survivors. Top Stroke Rehabil 2024; 31:97-103. [PMID: 37057761 PMCID: PMC10576011 DOI: 10.1080/10749357.2023.2202018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Each year, 795,000 Americans experience a stroke. As stroke mortality declines, more individuals are in the chronic phase of recovery (>6 months post-stroke). Over 80% of stroke survivors have multiple, chronic health conditions (MCC). While the relationship between MCC and mortality and function during acute recovery has been explored, less is known about how MCC burden affects participation in chronic stroke survivors. OBJECTIVE This study investigated whether MCC burden is related to participation in those with chronic stroke. METHODS Two hundred and sixty-six participants with chronic (≥6 months) stroke were included in this cross-sectional and retrospective analysis. Participants had a mean age of 62.2 ± 12.8 years, and time since stroke (TSS) of 36.0 ± 44.6 months (114F/152 M). Participants completed the 6-minute Walk Test (6MWT), Activities-Specific Balance Confidence Scale (ABC), Modified Cumulative Illness Rating Scale (MCIR) to quantify the presence and severity of chronic illness across 14 body systems, and the Stroke Impact Scale - Participation subscale (SIS-P). Participation (SIS-P) was the dependent variable. Independent variables were entered into a sequential regression model in three blocks: demographic variables, physical capacity (6MWT distance) and balance self-efficacy (ABC), and MCC burden (MCIR). RESULTS After adjusting for age, sex, and time since stroke, physical capacity and balance self-efficacy explained 31.4% (p < 0.001), and the MCC burden explained 2.0% (p = 0.004). Higher participation was related to lower MCC burden. CONCLUSIONS MCC burden is a significant contributor to variance in participation in chronic stroke survivors, above and beyond demographics, physical capacity, and self-efficacy, and therefore should be considered when creating rehabilitation programs to improve participation.
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Affiliation(s)
| | - Allison E Miller
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Wang C, Wang J, Wu X, Liu T, Wang F, Zhou H, Chen C, Shi L, Ma L, Liu T, Li C. Comprehensive review on sexual dimorphism to improve scalp acupuncture in nervous system disease. CNS Neurosci Ther 2024; 30:e14447. [PMID: 37665197 PMCID: PMC10805401 DOI: 10.1111/cns.14447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND With the development of modern medicine, the Traditional Chinese Medicine (TCM) combined with western medicine began to be produced and applied. Scalp acupuncture (SA) as a Chinese medicine based on neurological theory, has a great advantage compared with TCM in the treatment of nervous system diseases. METHOD In this paper, we analyze the physiological and pathological manifestations of sexual dimorphism (SD) to illustrate the necessity of SD treatment. In addition, we review the factors that can affect SD and analyze in physiological structure, function, and pathological neurons. Diseases (pathological basis, pathological manifestations, and incidence) and factors leading to gender differences, which to analyze the possibility of gender differences in SA. RESULT Furthermore, we creatively a new insight of SD-SA and provide the complete SD treatment cases on the basis of the existing SA in different kinds of diseases including stroke, migraine, attention deficit hyperactivity disorder (ADHD), and depression. CONCLUSION In summary, we believe that it is feasible to improve the clinical effectiveness of SA, which is able to promote the development of SA, and then provides an actionable evidence for the promotion of precision medicine in the future.
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Affiliation(s)
- Chaojie Wang
- Department of First Clinical Medical CollegeHeilongjiang University of Chinese MedicineHeilongjiangChina
| | - Jiening Wang
- Department of RehabilitationShanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xubo Wu
- Department of RehabilitationShanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
- School of Rehabilitation ScienceShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Tao Liu
- Department of BioengineeringImperial College LondonLondonUK
| | - Feng Wang
- First Affiliated Hospital of Heilongjiang University of Chinese MedicineHarbinChina
| | - Huanxia Zhou
- Department of RehabilitationShanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Chen Chen
- Second Affiliated Hospital of Heilongjiang University of Chinese MedicineHarbinChina
| | - Lijuan Shi
- School of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
| | - Lin Ma
- First Affiliated Hospital of Heilongjiang University of Chinese MedicineHarbinChina
| | - Tiantian Liu
- Department of RehabilitationShanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Cancheng Li
- School of Biological Science and Medical EngineeringBeihang UniversityBeijingChina
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Chan NH, Ng SSM. Psychometric properties of the Chinese version of the Arm Activity Measure in people with chronic stroke. Front Neurol 2023; 14:1248589. [PMID: 37808490 PMCID: PMC10556664 DOI: 10.3389/fneur.2023.1248589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The Arm Activity Measure was developed to assess active and passive functions of the upper limb in people with unilateral paresis, but a Chinese version is not available and its psychometric properties have not been specifically tested in people with stroke. This study aimed to translate and culturally adapt the Chinese version of the Arm Activity Measure (ArmA-C) and establish its psychometric properties in people with chronic stroke. Methods The psychometric properties of ArmA-C were determined in 100 people with chronic stroke. Results The ArmA-C had good test-retest reliability (intraclass correlation coefficients [ICC] = 0.87-0.93; quadratic weighted Kappa coefficients = 0.53-1.00). A floor effect was identified in section A of the ArmA-C. The content validity and internal consistency (Cronbach's alpha coefficients = 0.75-0.95) were good. The construct validity of the ArmA-C was supported by acceptable fit to the two-factor structure model and significant correlations with the Fugl-Meyer Assessment for Upper Extremity score, grip strength, the Wolf Motor Function Test score, the Trail Walking Test completion time, and the Oxford Participation and Activities Questionnaire scores. Conclusions The ArmA-C is reliable and valid for assessing active and passive functions in people with chronic stroke.
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Affiliation(s)
- Nga Huen Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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El Nahas N, Aref H, Kenawy FF, Georgy S, Abushady EM, Dawood NL, Hamdy S, Abdelmohsen N, Hassan Abdel Hamid Y, Roushdy T, Shokri H. Stroke in women: experience in a developing country. BMC Neurol 2023; 23:271. [PMID: 37460962 DOI: 10.1186/s12883-023-03314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Several studies have addressed gender differences in stroke. Yet, results are diverse, and research is still required in different populations. So, this study investigates variation in stroke according to gender in a developing country. METHODS This is a registry-based, retrospective observational cross-sectional study comparing men and women as regards age, risk factors, stroke severity, quality of services, and stroke outcome. RESULTS Data analyzed comprised 4620 patients. It was found that men outnumbered women, while women had an older age, more prevalence of hypertension and atrial fibrillation, with severer strokes and worse outcomes. However, there was no gender difference in promptness nor frequency of administration of revascularization therapies. CONCLUSION Despite the gender difference in risk factors and stroke severity, we could not detect any significant disparity in acute stroke services provided to either gender. Among age categories in women, we identified differences in acute ischemic stroke subtypes, and acute management in favor of older age.
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Affiliation(s)
- Nevine El Nahas
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | - Hany Aref
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | - Fatma Fathalla Kenawy
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt.
| | - Shady Georgy
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | - Eman Mones Abushady
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | - Noha Lotfy Dawood
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | - Sara Hamdy
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | - Nourhan Abdelmohsen
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | | | - Tamer Roushdy
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
| | - Hossam Shokri
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, PO, 11591, Egypt
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9
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Jameie M, Jameie M, Farahmand G, Ilkhani S, Magrouni H, Ranjbar Z, Heydari S, Shahbazi M, Kaeedi M, Amani K, Amiri R, Alizade F, Balali P, Amanollahi M, Pourghaz B, Ghabaee M. The Effect of Easily Implementable Changes to the "D's of Stroke Care" in Reducing Sex Disparity in Door-to-Needle Time. Neurologist 2023; 28:198-203. [PMID: 36054454 DOI: 10.1097/nrl.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Door-to-needle (DTN) is the duration between patient's arrival at the hospital and receiving intravenous thrombolysis in ischemic stroke settings, for which studies have reported delays in women. The "D's of stroke care" describes 8 steps (D1 to D8) in patients' time tracker. We implemented simple modifications to the "D's of stroke care" by splitting D4 and D6 steps into these substeps: patients' arrival to the emergency room (D4-A), early assessment by a neurologist (D4-B), neurologist decision on patient's eligibility to receive recombinant tissue plasminogen activator (D6-A), and patient's transfer to the stroke unit (D6-B). We evaluated the effect of these changes on reducing DTN time disparity between men and women. METHODS This study was conducted from September 2019 to August 2021, at a comprehensive stroke center. Patients were analyzed in 2 groups: group 1, before, and group 2, after using the modifications. Sex as the main variable of interest along with other covariates was regressed toward the DTN time. RESULTS In groups 1 and 2, 47 and 56 patients received intravenous thrombolysis, respectively. Although there was a significant difference in DTN≤1 hour between women and men in group 1 (36% vs. 52%, P =0.019), it was not significantly different in group 2 ( P =0.97). Regression analysis showed being female was a significant predictor of DTN>1 hour in group 1 (adjusted odds ratio=6.65, P =0.02), whereas after using the modifications, sex was not a significant predictor for delayed DTN. CONCLUSIONS Implementing these substeps reduced sex disparity in DTN time in our center.
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Affiliation(s)
- Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute
| | - Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute
| | - Ghasem Farahmand
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Saba Ilkhani
- Department of Surgery and Vascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hana Magrouni
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Zahra Ranjbar
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Sanaz Heydari
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Mojtaba Shahbazi
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Maryam Kaeedi
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Kiana Amani
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Rosita Amiri
- Iranian Center of Neurological Research, Neuroscience Institute
| | - Fateme Alizade
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Pargol Balali
- Iranian Center of Neurological Research, Neuroscience Institute
| | | | | | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
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10
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Irie F, Matsuo R, Nakamura K, Wakisaka Y, Ago T, Kitazono T, Kamouchi M. Sex Differences in Long-Term Functional Decline after Ischemic Stroke: A Longitudinal Observational Study from the Fukuoka Stroke Registry. Cerebrovasc Dis 2023; 52:409-416. [PMID: 36754022 DOI: 10.1159/000526940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/30/2022] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Data on sex differences in poststroke functional status for a period longer than 1 year based on large cohorts are sparse. This study aimed to determine whether there are sex differences in long-term functional decline after ischemic stroke. METHODS We tracked functional status for 5 years among 3-month survivors of acute ischemic stroke and compared outcomes between women and men using a large-scale hospital-based stroke registry in Fukuoka, Japan. Functional status was assessed using the modified Rankin Scale (mRS). Functional dependency was defined as an mRS score of 3, 4, or 5. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals of outcomes after adjusting for possible confounders. RESULTS A total of 8,446 patients (71.9 ± 12.5 years, 3,377 (40.0%) female patients) were enrolled in this study. Female sex was associated with a higher risk of functional dependency at 5 years poststroke even when adjusting for age, 3-month mRS score, and other confounding factors (multivariable-adjusted OR vs. men, 1.56 [95% confidence interval, 1.26-1.93]). This significant association of female sex with higher dependency at 5 years was also found among patients who were independent at 3 months poststroke. Subgroup analysis showed that increased risk of functional dependency in female patients was more marked in patients aged ≥75 years than in those aged <75 years (p for heterogeneity = 0.02). Conversely, female sex was associated with a lower risk of death. No sex difference was observed in stroke recurrence during 5 years poststroke. DISCUSSION/CONCLUSION This longitudinal observational study suggests that female sex was independently associated with an increased risk of functional decline in the chronic phase of stroke, especially in older patients. There was no sex difference in 5-year stroke recurrence, and thus, other factors might be involved in more significant deterioration of functional status in female survivors of ischemic stroke. Further studies are needed to elucidate underlying causes of sex differences in long-term functional decline after stroke.
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Affiliation(s)
- Fumi Irie
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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11
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Fang M, Xu C, Ma L, Sun Y, Zhou X, Deng J, Liu X. No sex difference was found in the safety and efficacy of intravenous alteplase before endovascular therapy. Front Neurol 2022; 13:989166. [DOI: 10.3389/fneur.2022.989166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background and purposePrior studies on sex disparities were post-hoc analyses, had limited treatment modalities, and had controversial findings. Our study aimed to examine whether sex difference modifies the effect of intravenous alteplase before endovascular therapy.MethodsWe conducted a multicenter prospective cohort study of 850 eligible patients with acute ischemic stroke who underwent endovascular therapy. A propensity score was utilized as a covariate to achieve approximate randomization of alteplase pretreatment. The baseline characteristics of women and men were compared. Logistic regression with interaction terms, adjusted for potential confounders, was used to investigate the effect of sex on the prognosis of bridging therapy.ResultsIn comparison to men, women were older [78.00 (70.00–84.00) vs. 67 (61.00–74.00), P < 0.001], had more atrial fibrillation (61.4 vs. 35.2%, P < 0.001), had a lower ASPECTS [10.00 (8.00–10.00) vs. 10 (9.00–10.00), P = 0.0047], and had a higher NIHSS score [17.00 (14.00–20.00) vs. 16 (13.00–19.00), P = 0.005]. Women tended to receive less bridging therapy (26.3 vs. 33%, P = 0.043) and more retrieval attempts [2.00 (1.00–2.00) vs. 1 (1.00–2.00), P = 0.026]. There was no sex difference in functional independence at 90 days after bridging therapy (OR 0.968, 95% CI 0.575–1.63), whereas men benefited more after EVT alone (OR 0.654, 95% CI 0.456–0.937). There were no sex-treatment interactions observed regardless of the location of the occlusion. There were no significant sex differences in all safety outcomes.ConclusionOur study could not confirm that sex modifies the treatment effect of intravenous alteplase before endovascular therapy. At the same time, we advocate for women to seek timely medical treatment.
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12
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Sex Differences in Ischemic Cerebral Infarction: A Nationwide German Real-Life Analysis from 2014 to 2019. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Female sex has been shown to be associated with an unfavorable outcome after ischemic stroke. In this nationwide analysis, we evaluate a large dataset of patients suffering from acute ischemic stroke to elucidate the factors associated with an increased risk of mortality after stroke in women. We analyzed a nationwide dataset from the German Federal Bureau of Statistics including 1,577,884 (761,537 female sex, 48.3%) in-hospital cases admitted between 1 January 2014 and 31 December 2019 with a primary diagnosis of acute ischemic cerebral infarction. Patients were analyzed regarding morbidity, treatments and in-hospital mortality. A multiple logistic regression analysis was performed, adjusted by patients’ risk profile including age, to evaluate the association of sex and in-hospital mortality. According to the median, women were older than men (79 years vs. 73 years). The multiple logistic regression analysis however revealed female sex remained an independent factor for an increased in-hospital mortality (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.11–1.14; p < 0.001). Women had a higher prevalence of relevant risk factors, namely arterial hypertension (77.0% vs. 74.7%), arterial fibrillation (33.3% vs. 25.6%), chronic heart failure (12.3% vs. 9.7%), chronic kidney disease (15.6% vs. 12.9%) and dementia (6.6% vs. 4.1%), but were less affected with respect to other relevant co-morbidities such as cerebrovascular disease (11.7% vs. 15.1%), coronary heart disease (11.7% vs. 18.8%), diabetes mellitus (26.4% vs. 29.6%), dyslipidemia (38.1% vs. 42.0%), ischemic heart disease (12.3% vs. 19.3%) and previous coronary artery bypass grafting (1.1% vs. 3.2%). Overall, therapeutic interventions were performed less frequently in women such as carotid endarterectomy (1.1% vs. 2.3%), carotid stent (0.7% vs. 1.4%), as well as hematoma drainage (0.1% vs. 0.2%), and renal replacement therapy (0.4% vs. 0.6%). Conclusions: Our nationwide analysis revealed a higher mortality rate after stroke in women. Nevertheless, women had fewer in-hospital complications and were also less likely to experience the severe effects of some important co-morbidities. The dataset, however, showed that women received surgical or interventional carotid treatments after stroke less often. It is important for research on sex disparities in stroke to keep these treatment frequency differences in mind.
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Phan HT, Reeves MJ, Gall S, Morgenstern LB, Xu Y, Lisabeth LD. Factors Contributing to Sex Differences in Health-Related Quality of Life After Ischemic Stroke: BASIC (Brain Attack Surveillance in Corpus Christi) Project. J Am Heart Assoc 2022; 11:e026123. [PMID: 36056724 PMCID: PMC9496431 DOI: 10.1161/jaha.122.026123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022]
Abstract
Background Women have been reported to have worse health-related quality of life (HRQoL) following stroke than men, but uncertainty exists over the reasons for the sex difference. Methods and Results We included all ischemic strokes registered with the BASIC (Brain Attack Surveillance in Corpus Christi) project (May 2010-December 2016), a population-based stroke study, who completed a 90-day outcome interview. Information on baseline characteristics was obtained from medical records and in-person interviews. HRQoL was measured by the 12-item short-form Stroke Specific Quality of Life Scale. Multivariable Tobit regression was used to estimate the mean difference in overall HRQoL scores (range, 1-5; higher indicating better HRQoL) between sexes and to identify contributing factors to the differences. We included 1061 cases with complete data on HRQoL and covariates (median age, 67 years; 51% women). In unadjusted analyses, women had poorer overall HRQoL than men (mean difference, -0.26 [95% CI, -0.40 to -0.13]). Contributors to this difference included sociodemographic/prestroke factors (eg, age, race and ethnicity, prestroke function), risk factors/comorbidities (eg, history of stroke, Alzheimer disease/dementia), and initial stroke severity. Sociodemographic/prestroke factors explained 62% of the sex difference (mean difference, -0.08 [95% CI, -0.21 to 0.04]). In a fully adjusted model that included adjustment for all confounding factors, the sex difference was eliminated and became nonsignificant (mean difference, -0.03 [95% CI, -0.16 to 0.09]). Conclusions Poorer HRQoL in women compared with men was observed and explained by the combination of sociodemographic and prestroke factors, including physical function before stroke and stroke severity. The findings suggest potential subgroups of women who might benefit from more targeted interventions before and after stroke to improve HRQoL.
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Affiliation(s)
- Hoang T. Phan
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
- Public Health Management DepartmentPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam
| | - Mathew J. Reeves
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMI
| | - Seana Gall
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
| | | | - Yuliang Xu
- Department of EpidemiologyUniversity of MichiganAnn ArborMI
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14
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Xu M, Amarilla Vallejo A, Cantalapiedra Calvete C, Rudd A, Wolfe C, O'Connell MDL, Douiri A. Stroke Outcomes in Women: A Population-Based Cohort Study. Stroke 2022; 53:3072-3081. [PMID: 35735007 DOI: 10.1161/strokeaha.121.037829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data are available on sex-related disparities in long-term outcomes after stroke. We estimated sex differences in various stroke long-term outcomes among survivors after stroke in a prospective 25-year follow-up study. METHODS Individuals recruited to the South London Stroke Register, an ongoing multi-ethnic urban-based population stroke register, from 1995 onward were included in the analyses (n=6687). The outcomes were death, subsequent stroke, activity of daily living, instrumental activity of daily living, cognitive impairment, depression, anxiety, and health-related quality of life. Kaplan-Meier curves were generated for mortality, stroke recurrence, and recurrence-free survival by sex and Cox proportional hazards model used to model sex differences up to 25 years. Generalized estimating equation were used to model sex differences in risk of self-reported stroke outcomes over 10 years poststroke outcomes, adjusting for age, preexisting activity of daily living, case-mix, stroke subtypes, and other potential confounding risk factors. RESULTS There were 49% women (mean age, 72 years; SD, 15.6) and 51% men (mean age, 67 years; SD, 14.3) in 6687 participants. Compared with men, women had 9% (95% CI, 3%-15%) lower covariate-adjusted risk of death and 6% (0%-13%) lower risk of stroke recurrence or death. Generally, women had significantly poorer outcomes in activity of daily living and anxiety than men, and the sex differences persisted to up to 5 years after stroke. Women also had poorer health-related quality of life in physical (β=-2.06 [95% CI, -3.01 to -1.10]) and mental domains (β=-1.48 [95% CI, -2.44 to -0.52]). Although not significant, there was a suggestive trend for poorer outcomes in cognitive impairment and depression in women. No significant difference in stroke recurrence were found between men and women. CONCLUSIONS Female patients with stroke tended to have better covariate-adjusted survival but poorer outcomes among survivors than male patients, with deficits persisting to up to 5 years poststroke.
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Affiliation(s)
- Min Xu
- School of Population Health and Environmental Sciences, King's College London, United Kingdom. (M.X., C.C.C., A.R., C.W., M.D.L.O., A.D.)
| | | | - Clara Cantalapiedra Calvete
- School of Population Health and Environmental Sciences, King's College London, United Kingdom. (M.X., C.C.C., A.R., C.W., M.D.L.O., A.D.)
| | - Anthony Rudd
- School of Population Health and Environmental Sciences, King's College London, United Kingdom. (M.X., C.C.C., A.R., C.W., M.D.L.O., A.D.).,Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (A.R.)
| | - Charles Wolfe
- School of Population Health and Environmental Sciences, King's College London, United Kingdom. (M.X., C.C.C., A.R., C.W., M.D.L.O., A.D.).,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom (C.W., A.D.).,NIHR Applied Research Collaboration (ARC) South London, United Kingdom (C.W., A.D.)
| | - Matthew D L O'Connell
- School of Population Health and Environmental Sciences, King's College London, United Kingdom. (M.X., C.C.C., A.R., C.W., M.D.L.O., A.D.)
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, King's College London, United Kingdom. (M.X., C.C.C., A.R., C.W., M.D.L.O., A.D.).,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom (C.W., A.D.).,NIHR Applied Research Collaboration (ARC) South London, United Kingdom (C.W., A.D.)
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Ospel JM, Schaafsma JD, Leslie-Mazwi TM, Amin-Hanjani S, Asdaghi N, Gordon-Perue GL, Couillard P, Hadidi NN, Bushnell C, McCullough LD, Goyal M. Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e396-e406. [PMID: 35695016 DOI: 10.1161/str.0000000000000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.
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16
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Zhou Y, Wu D, Yan S, Xie Y, Zhang S, Lv W, Qin Y, Liu Y, Liu C, Lu J, Li J, Zhu H, Liu WV, Liu H, Zhang G, Zhu W. Feasibility of a Clinical-Radiomics Model to Predict the Outcomes of Acute Ischemic Stroke. Korean J Radiol 2022; 23:811-820. [PMID: 35695316 PMCID: PMC9340229 DOI: 10.3348/kjr.2022.0160] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Objective To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825–0.910) in the training cohort and 0.890 (0.844–0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.
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Affiliation(s)
- Yiran Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Su Yan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Xie
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhi Lv
- Department of Artificial Intelligence, Julei Technology, Wuhan, China
| | - Yuanyuan Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufei Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengxia Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongquan Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Huan Liu
- Advanced Application Team, GE Healthcare, Shanghai, China
| | - Guiling Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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17
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Ugidos IF, Pistono C, Korhonen P, Gómez-Budia M, Sitnikova V, Klecki P, Stanová I, Jolkkonen J, Malm T. Sex Differences in Poststroke Inflammation: a Focus on Microglia Across the Lifespan. Stroke 2022; 53:1500-1509. [PMID: 35468000 DOI: 10.1161/strokeaha.122.039138] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Stroke is one of the leading causes of death worldwide and currently only few therapeutic options are available. Stroke is a sexually dimorphic disease contributing to the difficulty in finding efficient treatments. Poststroke neuroinflammation is geared largely by brain microglia and infiltrating peripheral immune cells and largely contributes to sex differences in the outcome of stroke. Microglia, since very early in the development, are sexually divergent, imprinting specific sex-related features. The diversity in terms of microglial density, morphology, and transcriptomic and proteomic profiles between sexes remains in the adulthood and is likely to contribute to the observed sex-differences on the postischemic inflammation. The impact of sexual hormones is fundamental: changes in terms of risk and severity have been observed for females before and after menopause underlining the importance of altered circulating sexual hormones. Moreover, aging is a driving force for changes that interact with sex, shifting the inflammatory response in a sex-dependent manner. This review summarizes the present literature on sex differences in stroke-induced inflammatory responses, with the focus on different microglial responses along lifespan.
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Affiliation(s)
- Irene F Ugidos
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.).,Department of Pharmacology, School of Medicine, Tulane University, New Orleans, LA (I.F.U.)
| | - Cristiana Pistono
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
| | - Paula Korhonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
| | - Mireia Gómez-Budia
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
| | - Valeriia Sitnikova
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
| | - Pamela Klecki
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
| | - Iveta Stanová
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
| | - Jukka Jolkkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
| | - Tarja Malm
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio (I.F.U., C.P., P.K., M.G.-B., V.S., P.K., I.S., J.J., T.M.)
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18
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Madsen TE, Samaei M, Pikula A, Yu AYX, Carcel C, Millsaps E, Yalamanchili RS, Bencie N, Dula AN, Leppert M, Rundek T, Dreyer RP, Bushnell C. Sex Differences in Physical Activity and Incident Stroke: A Systematic Review. Clin Ther 2022; 44:586-611. [PMID: 35418311 PMCID: PMC9195871 DOI: 10.1016/j.clinthera.2022.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Physical inactivity, a modifiable risk factor for cardiovascular disease, is independently associated with stroke. Though some prior data have suggested sex differences in levels of physical activity, whether there are sex differences in the role of physical activity in primary stroke prevention is largely unknown. This systematic review identifies and describes recent findings on sex differences in the association between physical activity and incident (first-ever) stroke. This review also describes the current evidence on the strength of the association between physical activity and a reduced stroke risk in women in particular. METHODS Using a prespecified strategy, PubMed/MEDLINE and Cochrane Central were searched to identify observational studies or trials published from 2000 to 2020 and reporting sex differences in physical activity and incident stroke. To be included, among other criteria, studies had to include sex-specific effect estimates from women, men, or both. Titles, abstracts, and full-text articles were screened to identify studies meeting the inclusion criteria, and adjusted sex-specific estimates of the association between physical activity and incident stroke for total stroke (ischemic plus hemorrhagic) or ischemic stroke were abstracted. FINDINGS Thirty-seven studies met the inclusion criteria. Of 17 studies that included data on total incident stroke (ischemic and hemorrhagic combined) in both women and men, 7 (41%) showed similar associations between physical activity and incident stroke between women and men, 6 (35%) suggested a significant effect in women but not in men, and 3 (18%) showed a significant effect in men but not in women. Of 10 studies that included data on ischemic stroke in women and men, 5 (50%) suggested similar effects in women and men, 4 (40%) suggested a significant effect in women but not in men, and 1 (10%) showed an effect in men but not women. In women specifically, the majority of included studies demonstrated a reduced risk for incident stroke with physical activity, with relative risk reductions ranging from 11% to 72%, though most estimates fell between 20% and 40%. IMPLICATIONS The majority of studies indicated a clear association between physical activity and a reduction in stroke risk. Studies were split as to the potential for sex differences in this association. Future prospective investigations should identify strategies for the use of increased physical activity for primary stroke prevention, with sex-specific considerations as warranted. The data on sex-specific dose-response relationship between physical activity and stroke risk are inconclusive and warrant more research.
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Affiliation(s)
- Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School, and the Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
| | - Mehrnoosh Samaei
- Department of Emergency Medicine, Division of Sex and Gender in Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Aleksandra Pikula
- Department of Medicine (Neurology), University of Toronto, University Health Networks, Toronto, Ontario, Canada
| | - Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Nicole Bencie
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Adrienne N Dula
- Departments of Neurology and Diagnostic Medicine, Dell Medical School, University of Texas, Austin, Texas
| | - Michelle Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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19
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Kawamura K, Murayama K, Takamura J, Minegishi S. Effect of a weekly functional independence measure scale on the recovery of patient with acute stroke: A retrospective study. Medicine (Baltimore) 2022; 101:e28974. [PMID: 35356904 PMCID: PMC10684118 DOI: 10.1097/md.0000000000028974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Excessive assistance may decrease stroke patients' physical activity and make them more dependent on assistance. We have structured a system that provides an ADL (activities of daily living) educational program that focuses on stroke patients' toileting in our daily clinical practice. Here, we investigated the effect of a functional independence measure (FIM) scale on the recovery of patients with acute stroke.We retrospectively collected the data of 407 stroke patients from the medical record system of our emergency hospital in Tsukuba, Japan. The enrolled stroke patients (n = 373) were divided into FIM and control groups. Both groups received the standard treatment, but for the FIM group, ward and rehabilitation staff calculated the toilet FIM score for patients 1 ×/wk. The FIM scale measures the amount of assistance a patient needs to perform activities of daily living and is often used in rehabilitation settings. The rehabilitation staff then instructed the ward staff about better assistance methods based on each patient's physical function and executive dysfunction. We evaluated the usefulness of the FIM scale was based on the patients' FIM scores at discharge and improvements in their scores.The recoveries of the total, motor, and cognitive FIM scores recovery at discharge were significantly greater in the FIM group compared with the control group (68.0 vs 45.0, P = .004; 41.0 vs 24.0, P = .005; and 24.0 vs 20.0, P = .007, respectively). The use of the FIM scale contributes to the patients' recovery of physical function and cognitive function.The FIM scale can contribute to stroke patients' recovery of activities of daily living.
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Affiliation(s)
- Kenta Kawamura
- Correspondence: Kenta Kawamura, Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan (e-mail: ).
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20
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Neuromuscular Stimulation as an Intervention Tool for Recovery from Upper Limb Paresis after Stroke and the Neural Basis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuromodulators at the periphery, such as neuromuscular electrical stimulation (NMES), have been developed as add-on tools to regain upper extremity (UE) paresis after stroke, but this recovery has often been limited. To overcome these limits, novel strategies to enhance neural reorganization and functional recovery are needed. This review aims to discuss possible strategies for enhancing the benefits of NMES. To date, NMES studies have involved some therapeutic concerns that have been addressed under various conditions, such as the time of post-stroke and stroke severity and/or with heterogeneous stimulation parameters, such as target muscles, doses or durations of treatment and outcome measures. We began by identifying factors sensitive to NMES benefits among heterogeneous conditions and parameters, based on the “progress rate (PR)”, defined as the gains in UE function scores per intervention duration. Our analysis disclosed that the benefits might be affected by the target muscles, stroke severity and time period after stroke. Likewise, repetitive peripheral neuromuscular magnetic stimulation (rPMS) is expected to facilitate motor recovery, as already demonstrated by a successful study. In parallel, our efforts should be devoted to further understanding the precise neural mechanism of how neuromodulators make UE function recovery occur, thereby leading to overcoming the limits. In this study, we discuss the possible neural mechanisms.
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21
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Regenhardt RW, Turner AC, Hirsch JA, Young MJ, Alotaibi NM, Stapleton CJ, Patel AB, Leslie-Mazwi TM, Rost NS, Etherton MR. Sex-specific differences in presentations and determinants of outcomes after endovascular thrombectomy for large vessel occlusion stroke. J Neurol 2022; 269:307-315. [PMID: 34052896 PMCID: PMC8628020 DOI: 10.1007/s00415-021-10628-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/16/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Sex-specific differences in ischemic stroke outcomes are prevalent. We sought to investigate sex differences in the determinants of reperfusion and functional outcomes after endovascular thrombectomy (EVT) for emergent large vessel occlusion ischemic stroke (ELVO). METHODS Patients presenting to a single referral center with an anterior circulation ELVO that underwent EVT from 2011 to 2019 were included in this retrospective analysis. Sex differences in history, presentation, adequate reperfusion (TICI 2b-3), and 90-day good outcome [delta modified Rankin Scale (mRS) ≤ 2 from pre-stroke] were examined. Multivariable logistic regression analyses were performed to assess sex-specific associations with outcomes. RESULTS Three hundred and eighty-one consecutive ELVO patients were identified. Women (N = 193) were older (75 vs 64 years, p < 0.0001), had more pre-stroke disability (17% vs 9%, p = 0.032), more atrial fibrillation (41% vs 30%, p = 0.033), but less carotid atherosclerosis (8% vs 16%, p = 0.027). Rates of TICI 2b-3 and good outcome were similar between sexes. Carotid atherosclerosis (OR 0.315, 95% CI 0.130, 0.762) and dissection (OR 0.124, 95% CI 0.027, 0.569) independently decreased the odds of TICI 2b-3 among men but not women. Older age, more severe stroke, and not achieving TICI 2b-3 independently decreased the odds of good outcome among both sexes, while prior stroke (OR 0.258, 95% CI 0.083, 0.797) and hemorrhagic transformation (OR 0.111, 0.021, 0.592) were determinants exclusive to men. CONCLUSION In a real-world analysis of ELVO stroke patients treated with EVT, we found that despite advanced age and more pre-stroke disability, women have comparable reperfusion rates and functional outcomes compared to men. Sex-specific determinants of reperfusion and functional outcome were identified that require further study.
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Affiliation(s)
- Robert W Regenhardt
- Neurology, Massachusetts General Hospital, 55 Fruit St, WAC-7-721, Boston, MA, USA. .,Neurosurgery, Massachusetts General Hospital, 55 Fruit St, WAC-7-721, Boston, MA, USA.
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22
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Kautzky-Willer A, Harreiter J, Thomas A, Burger J, Schneeweiß U, Deischinger C, Klein W, Moser H. Women With Cerebral Infarction Feature Worse Clinical Profiles at Admission but Comparable Success to Men During Long-Term Inpatient Neurorehabilitation. Front Aging Neurosci 2021; 13:663215. [PMID: 34867261 PMCID: PMC8637730 DOI: 10.3389/fnagi.2021.663215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/27/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: Little is known about possible sex and gender differences in post-stroke neurorehabilitation outcomes. We aimed to analyze if functional performance, prevalence and impact of comorbidities at admission, and success of inpatient stroke-neurorehabilitation differ between men and women. Methods: Retrospective cohort analysis of 1,437 men and 907 women with prior cerebral infarction treated at a neurorehabilitation clinic between 2012 and 2017; multiple linear regression was used to examine the influence of sex/gender as well as multiple confounders on health and functional outcomes. The main outcome measures were Barthel index (BI) at admission and its change during 4 weeks inpatient neurorehabilitation. Results: Men had been diagnosed with osteoporosis less frequently than women but more often with type 2 diabetes mellitus, coronary artery or chronic kidney disease (p ≤ 0.01). Although twice as many women presented with pre-stroke depression compared to men, the risk of post-stroke depression detected during rehabilitation was comparable. Men were more likely to have less than 30 days between diagnosis and neurorehabilitation start than women (p < 0.03). At admission, women exhibited less autonomy, a lower BI, a higher pain score and worse 2-min walk test (2′WT) compared to men (p < 0.001). Among males osteoporosis and peripheral artery disease independently predicted BI at admission, in women it was pre-stroke depression, dementia, and arterial fibrillation. During neurorehabilitation, both sexes improved regarding BI, pain and walk tests (p < 0.001). Despite comparable rehabilitation effectiveness, women still had worse functional outcomes than males at discharge. Time after stroke to start of neurorehabilitation and length of the stay but, most strongly, the simple 2′WT at admission, and in women, pain intensity independently predicted post-stroke functional status and recovery. Conclusion: Women presented with worse functional status at admission to neurorehabilitation. Although men and women showed similar rehabilitation effectiveness, women still displayed worse clinical outcome measures and higher levels of pain at discharge. Early access and gender-sensitive, personalized post-stroke care with more focus on different comorbidities and psychosocial factors like pain levels and management, could further improve neurorehabilitation outcomes.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Institute, Gars am Kamp, Austria.,Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Anita Thomas
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Johannes Burger
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ulrich Schneeweiß
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Carola Deischinger
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfhard Klein
- Neurologisches Therapiezentrum Gmundnerberg, Altmünster, Austria
| | - Hermann Moser
- Neurologisches Therapiezentrum Gmundnerberg, Altmünster, Austria
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23
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Barbeau-Meunier CA, Bernier M, Côté S, Gilbert G, Bocti C, Whittingstall K. Sexual dimorphism in the cerebrovascular network: Brain MRI shows lower arterial density in women. J Neuroimaging 2021; 32:337-344. [PMID: 34861082 DOI: 10.1111/jon.12951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Accumulating evidence suggests that there is a sexual dimorphism in brain health, with women exhibiting greater disability following strokes of comparable size and having a higher prevalence of cognitive impairment later in life. Despite the critical implication of the cerebrovascular architecture in brain perfusion and brain health, it remains unclear whether structural differences in vessel density exist across the sexes. METHODS In this study, we used high-density MRI imaging to characterize the intracerebral arterial and venous density of 28 (14 women) sex-matched healthy young volunteers in vivo. Using an in-house vessel segmentation algorithm, we quantified and compared these vascular features across the cortical and subcortical deep gray matter, white matter, and periventricular white matter. RESULTS We found that, on average, women have reduced intracerebral arterial density in comparison to men (F 2.34 ± 0.48%, M 2.67 ± 0.39%; p<.05). This difference was most pronounced in the subcortical deep gray matter (F 1.78 ± 0.53%, M 2.38 ± 0.82%; p<.05) and periventricular white matter (F 0.68 ± 0.15%, M 1.14 ± 0.33%; p<.0005), indicating a potential sex-specific vulnerability to hypoperfusion in areas critical to core cerebral functions. In contrast, venous density did not exhibit a significant difference between sexes. CONCLUSIONS While this research remains exploratory, it raises important pathophysiological considerations for brain health, adverse cerebrovascular events, and dementia across the sexes. Our findings also highlight the need to take into account sex differences when investigating cerebral characteristics in humans.
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Affiliation(s)
| | - Michaël Bernier
- Martinos Center - MGH - Harvard Medical School, Charlestown, Massachusetts, USA
| | - Samantha Côté
- Department of Nuclear Medicine and Radiobiology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare Canada, Markham, Ontario, Canada
| | - Christian Bocti
- Research Center on Aging, Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Kevin Whittingstall
- Department of Nuclear Medicine and Radiobiology, University of Sherbrooke, Sherbrooke, Quebec, Canada
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24
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de Miguel-Yanes JM, Jiménez-García R, López-de-Andrés A, Hernández-Barrera V, de Miguel-Díez J, Méndez-Bailón M, Muñoz-Rivas N, Pérez-Farinós N, Lopez-Herranz M. The influence of sex on ischemic stroke incidence, therapeutic procedures and in-hospital mortality: Results of the Spanish National Hospital Discharge. Int J Clin Pract 2021; 75:e14984. [PMID: 34637167 DOI: 10.1111/ijcp.14984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/23/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Previous research has revealed sex-related differences in outcomes for people admitted to hospitals for ischemic stroke. We aimed to analyse the incidence, use of invasive procedures and in-hospital outcomes of ischemic stroke in Spain (2016-2018) using the Spanish National Hospital Discharge Database. We sought sex-related differences in incidence and in-hospital outcomes over time. METHODS We estimated the incidence of ischemic stroke in men and women. We analysed comorbidities (Charlson's comorbidity index, cardiovascular risk factors, alcohol abuse and atrial fibrillation), procedures (mechanical ventilation, endovascular thrombectomy and thrombolytic therapy) and outcomes. We matched each woman with a man with identical age, type of ischemic stroke and year of hospitalisation. We built Poisson regression models to obtain adjusted incidence rate ratios (IRRs). We tested in-hospital mortality (IHM) with logistic regression analyses. RESULTS Ischemic stroke was coded in 172 255 patients aged ≥35 years (92 524 men 53.7%). Men showed higher incidence rates (216.9 vs. 172.3/105 ; P < .001; IRR = 1.57 (95% CI:1.55-1.59) than women. After matching, the use of endovascular thrombectomy (5.1% vs. 4.0%; P < .001) and thrombolytic therapy (7.6% vs. 6.8%; P < .001) was higher among women. IHM was significantly higher in women than in matched men (11.2% vs. 10.4%; P < .001). Women had a lower IHM than matched men when endovascular thrombectomy (9.4% vs. 12.1%; P = .001) or thrombolytic therapy (6.7% vs. 8.3%; P = .003) was coded. Patients of both sexes admitted for ischemic stroke who received thrombolytic therapy had lower IHM (OR = 0.76; 95% CI:0.68-0.85 among men; and OR = 0.58; 95% CI:0.52-0.64 among women), but endovascular thrombectomy was associated with a lower IHM only among women (OR = 0.58; 95% CI:0.51-0.66). After multivariable adjusting, women admitted to the hospital for ischemic stroke had a significantly higher IHM than men (OR = 1.16; 95% CI:1.12-1.21). CONCLUSION Men had higher incidence rates of ischemic stroke than women. Women more often underwent thrombolytic therapy and endovascular thrombectomy but had a higher IHM.
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Affiliation(s)
- José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Napoleón Pérez-Farinós
- Public Health and Psychiatry Department, Faculty of Medicine, Universidad de Málaga, Málaga, Spain
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
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25
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MacDonald SL, Hall RE, Bell CM, Cronin S, Jaglal SB. Sex differences in the outcomes of adults admitted to inpatient rehabilitation after stroke. PM R 2021; 14:779-785. [PMID: 34181304 DOI: 10.1002/pmrj.12660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/17/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Several differences have been reported between male and female patients with stroke in clinical and sociodemographic features, treatment, and outcomes. Potential effects in the inpatient rehabilitation population are unclear. OBJECTIVE To evaluate the differences between male and female patients in discharge functional status, length of stay, and discharge home after inpatient rehabilitation for stroke. DESIGN Retrospective, population-based cohort study. SETTING Inpatient rehabilitation centers in Ontario, Canada. PARTICIPANTS Male (N = 10,684) and female (N = 9459) patients discharged from acute care between September 1, 2012 and August 31, 2017, with a diagnosis of stroke and subsequently admitted to inpatient rehabilitation. EXPOSURE VARIABLE Female sex. MAIN OUTCOME MEASURES Discharge Functional Independence Measure (FIM) score, length of stay, and discharge home. RESULTS Female patients had a lower functional status at discharge (mean FIM score 94.1 vs. 97.8, p < .001) and a lower proportion were discharged home (81.1% vs. 82.9%, p = .001). Female and male patients had similar rehabilitation length of stay (mean 31.8 vs. 31.7 days, p = .90). In the adjusted analyses, there was no difference in discharge functional status between male and female patients (FIM score β -.20 [95% confidence interval [CI] -0.64 to 0.25]). Female patients had a mean length of stay 2% shorter (0.98 [95% CI 0.96-0.99]) and a higher odds of discharge home (odds ratio [OR] 1.14 [95% CI 1.05-1.24]). CONCLUSIONS There were no clinically significant sex differences in outcomes after inpatient rehabilitation for stroke. Observed sex disparities in the general stroke population may not be directly applicable to individuals undergoing inpatient rehabilitation.
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Affiliation(s)
- Shannon L MacDonald
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sinai Health, Toronto, Ontario, Canada
| | - Ruth E Hall
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sinai Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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26
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Abstract
In the last decades, there has been great progress in the field of stroke. With the introduction of acute therapies (intravenous thrombolysis and intra-arterial treatment), the outcome after stroke has improved significantly. Better prevention, improved acute therapy, and acute rehabilitation improved the morbidity and mortality rate after stroke. Gender differences in risk factors and epidemiology have been known for a long time, but lately attention to gender differences in stroke has increased. The aim of this mini-review is to demonstrate gender disparities in stroke with a focus on epidemiology, specific risk factors (gender-specific and unspecific), and outcomes. The influence of some risk factors for stroke is stronger in women (atrial fibrillation and hypertension) and there are risk factors exclusive to women such as pregnancy, pregnancy-associated hypertensive disorders, oral contraceptives, and hormonal replacement treatment. Data on the impact of other risk factors are inconsistent. The worse outcome after a stroke is mainly caused by demographic characteristics in women. Specific gender research is needed to better understand gender disparities in stroke to improve prevention strategies and treatment for women.
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Affiliation(s)
- Sydney Corbière
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Barbara Tettenborn
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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27
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Talavera B, Gómez-Vicente B, Martínez-Galdámez M, López-Cancio E, García-Cabo C, Castellanos M, Roel A, Tejada-Meza H, Marta-Moreno J, Pérez-Lázaro C, Navarro-Pérez MP, Bravo-Anguiano Y, Bártulos-Iglesias M, Tejada-García J, Rodrigo-Stevens G, Martínez-Zabaleta M, de la Riva P, Timiraos-Fernández JJ, Del Mar Freijo M, Luna A, García-Sánchez JM, Del Carmen Gil-Alzueta M, Palacio-Portilla EJ, Jiménez-López Y, López-Mesonero L, Redondo-Robles L, Mayo-Iscar A, Arenillas JF. Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke. Stroke 2021; 52:2210-2217. [PMID: 34011172 DOI: 10.1161/strokeaha.120.032066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Blanca Talavera
- Neurology Department (B.T., B.G.-V., J.F.A.), Hospital Clínico Universitario de Valladolid, Spain
| | - Beatriz Gómez-Vicente
- Neurology Department (B.T., B.G.-V., J.F.A.), Hospital Clínico Universitario de Valladolid, Spain
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology Unit, Radiology Department (M.M.-G.), Hospital Clínico Universitario de Valladolid, Spain
| | - Elena López-Cancio
- Neurology Department, Hospital Universitario Central de Asturias, Spain (E.L.-C., C.G.-C.)
| | - Carmen García-Cabo
- Neurology Department, Hospital Universitario Central de Asturias, Spain (E.L.-C., C.G.-C.)
| | - Mar Castellanos
- A Coruña Biomedical Research Insitute, Neurology Department, Complexo Hospitalario Universitario A Coruña, Spain (M.C., A.R.)
| | - Alexia Roel
- A Coruña Biomedical Research Insitute, Neurology Department, Complexo Hospitalario Universitario A Coruña, Spain (M.C., A.R.)
| | - Herbert Tejada-Meza
- Interventional Neuroradiology Unit, Department of Radiology (H.T.-M.), Hospital Universitario Miguel Servet, Spain
| | - Javier Marta-Moreno
- Department of Neurology (J.M.-M.), Hospital Universitario Miguel Servet, Spain
| | - Cristina Pérez-Lázaro
- Instituto de Investigación Sanitaria de Aragon, Neurology Department, Hospital Clínico Universitario Lozano Blesa, Spain (C.P.-L., M.P.N.-P.)
| | - María Pilar Navarro-Pérez
- Instituto de Investigación Sanitaria de Aragon, Neurology Department, Hospital Clínico Universitario Lozano Blesa, Spain (C.P.-L., M.P.N.-P.)
| | - Yolanda Bravo-Anguiano
- Neurology Department, Complejo Asistencial Universitario de Burgos, Spain (Y.B.-A., M.B.-I.)
| | | | - Javier Tejada-García
- Neurology Department, Complejo Asistencial Universitario de León, Spain (J.T.-G., G.R.-S.)
| | | | | | - Patricia de la Riva
- Neurology Department, Hospital Donostia-Donostia Ospitalea, Spain (M.M.-Z., P.d.l.R)
| | | | | | - Alain Luna
- Neurology Department, Hospital Universitario de Cruces, Spain (M.d.M.F., A.L.)
| | | | | | | | - Yésica Jiménez-López
- Neurology Department, Hospital Universitario Marqués de Valdecilla, Spain (E.J.P.-P., Y.J.-L.)
| | - Luis López-Mesonero
- Neurology Department, Hospital Universitario de Salamanca, Spain (L.L.-M., L.R.-R.)
| | - Laura Redondo-Robles
- Neurology Department, Hospital Universitario de Salamanca, Spain (L.L.-M., L.R.-R.)
| | - Agustín Mayo-Iscar
- Department of Statistics and O.R, Biostatistics & IMUVA, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain (A.M.-I.)
| | - Juan F Arenillas
- Neurology Department (B.T., B.G.-V., J.F.A.), Hospital Clínico Universitario de Valladolid, Spain.,Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid - Consejo Superior de Investigaciones Científicas (Madrid) (J.F.A.)
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Predicting Decreased Activities of Daily Living in Patients with Moyamoya Disease after Revascularization: Development and Assessment of a New Predictive Nomogram. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6624245. [PMID: 33997029 PMCID: PMC8105101 DOI: 10.1155/2021/6624245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to develop and validate a nomogram model to predict the risk of decreased activities of daily living (ADLs) in patients with moyamoya disease (MMD) following revascularization. The nomogram model was constructed based on data from 292 patients with MMD that were treated at Qilu Hospital of Shandong University from January 2018 to June 2019. The prediction model was assessed using a dataset of 119 patients with MMD collected from July 2019 to June 2020. Patients were evaluated with a general information questionnaire and the Mini Mental Status Examination, Hospital Anxiety and Depression Scale, Social Support Rating Scale, and ADL Scale. Multivariable logistic regression analysis was applied to build a prediction model incorporating the features selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the prediction model were assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis. Predictors contained in the nomogram included gender, age, monthly income, hypertension, and cognitive function and depression scores. The areas under the ROC curves of the training and testing datasets were 0.938 and 0.853, respectively. The prediction model displayed good calibration, and the decision curve analysis showed that it had a wide range of clinical applications. This novel predictive could be conveniently used to predict the risk of the decreased living activity ability in patients with MMD.
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Abstract
Sex differences exist in the epidemiology, care, and outcomes of stroke. This article highlights recent advances in our understanding of sex and gender differences in the benefits of endovascular therapy, outcomes after stroke and transient neurological events, and the potential to prevent stroke in women with a history of hypertensive disorders of pregnancy.
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Affiliation(s)
- Moira K Kapral
- Department of Medicine (Division of General Internal Medicine), University of Toronto, Ontario, Canada (M.K.K.)
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (C.B.)
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30
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Deb-Chatterji M, Schlemm E, Flottmann F, Meyer L, Alegiani A, Brekenfeld C, Fiehler J, Gerloff C, Thomalla G. Sex Differences in Outcome After Thrombectomy for Acute Ischemic Stroke are Explained by Confounding Factors. Clin Neuroradiol 2020; 31:1101-1109. [PMID: 33346850 PMCID: PMC8648700 DOI: 10.1007/s00062-020-00983-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to analyze sex differences in outcome after thrombectomy for acute ischemic stroke in clinical practice in a large prospective multicenter registry. METHODS Data of consecutive stroke patients treated with thrombectomy (June 2015-April 2018) derived from an industry-independent registry (German Stroke Registry-Endovascular Treatment) were prospectively analyzed. Multivariable binary logistic regression analyses were applied to determine whether sex is a predictor of functional independence outcome (defined as a modified Rankin scale [mRS] 0-2) 90 days after stroke. RESULTS In total, 2316 patients were included in the analysis, 1170 (50.5%) were female and 1146 (49.5%) were male. Women were older (median age 78 vs. 72 years; p < 0.001) and more frequently had a prestroke functional impairment defined by mRS >1 (24.8% vs. 14.1%; p < 0.001). In unadjusted analyses, independent outcome at 90 days was less frequent in women (33.2%) than men (40.6%; p < 0.001). Likewise, mortality was higher in women than in men (30.7% vs. 26.4%; p = 0.024). In adjusted regression analyses, however, sex was not associated with outcome. Lower age, a lower baseline National Institutes of Health Stroke Scale score, a higher Alberta Stroke Program Early CT score, prestroke functional independence, successful reperfusion, and concomitant intravenous thrombolysis therapy predicted independent outcome. CONCLUSION Women showed a worse functional outcome after thrombectomy for acute ischemic stroke in clinical practice; however, after adjustment for crucial confounders sex was not a predictor of outcome. The difference in outcome thus appears to result from differences in confounding factors such as age and prestroke functional status.
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Affiliation(s)
- Milani Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Interventional Neuroradiology and Diagnostics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Interventional Neuroradiology and Diagnostics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Interventional Neuroradiology and Diagnostics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Interventional Neuroradiology and Diagnostics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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31
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Sex Differences in Endovascular Treatment for Stroke: A Population-based Analysis. Can J Neurol Sci 2020; 48:479-486. [PMID: 33081850 DOI: 10.1017/cjn.2020.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acute ischemic stroke may affect women and men differently. We aimed to evaluate sex differences in outcomes of endovascular treatment (EVT) for ischemic stroke due to large vessel occlusion in a population-based study in Alberta, Canada. METHODS AND RESULTS Over a 3-year period (April 2015-March 2018), 576 patients fit the inclusion criteria of our study and constituted the EVT group of our analysis. The medical treatment group of the ESCAPE trial had 150 patients. Thus, our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database methodology. The primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at their premorbid living situation without an increase in the level of care within 90 days of the index stroke event. In adjusted analysis, EVT was associated with an increase of 90-day home-time by an average of 6.08 (95% CI -2.74-14.89, p-value 0.177) days in women compared to an average of 11.20 (95% CI 1.94-20.46, p-value 0.018) days in men. Further analysis revealed that the association between EVT and 90-day home-time in women was confounded by age and onset-to-treatment time. CONCLUSIONS We found a nonsignificant nominal reduction of 90-day home-time gain for women compared to men in this province-wide population-based study of EVT for large vessel occlusion, which was only partially explained by confounding.
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32
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Ospel JM, Menon BK, Demchuk AM, Almekhlafi MA, Kashani N, Mayank A, Fainardi E, Rubiera M, Khaw A, Shankar JJ, Dowlatshahi D, Puig J, Sohn SI, Ahn SH, Poppe A, Calleja A, Hill MD, Goyal M. Clinical Course of Acute Ischemic Stroke Due to Medium Vessel Occlusion With and Without Intravenous Alteplase Treatment. Stroke 2020; 51:3232-3240. [PMID: 33070714 DOI: 10.1161/strokeaha.120.030227] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Available data on the clinical course of patients with acute ischemic stroke due to medium vessel occlusion (MeVO) are mostly limited to those with M2 segment occlusions. Outcomes are generally better compared with more proximal occlusions, but many patients will still suffer from severe morbidity. We aimed to determine the clinical course of acute ischemic stroke due to MeVO with and without intravenous alteplase treatment. METHODS Patients with MeVO (M2/M3/A2/A3/P2/P3 occlusion) from the INTERRSeCT (The Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) and PRoveIT (Precise and Rapid Assessment of Collaterals Using Multi-Phase CTA in the Triage of Patients With Acute Ischemic Stroke for IA Therapy) studies were included. Baseline characteristics and clinical outcomes were summarized using descriptive statistics. The primary outcome was a modified Rankin Scale score of 0 to 1 at 90 days, describing excellent functional outcome. Secondary outcomes were the common odds ratio for a 1-point shift across the modified Rankin Scale and functional independence, defined as modified Rankin Scale score of 0 to 2. We compared outcomes between patients with versus without intravenous alteplase treatment and between patients who did and did not show recanalization on follow-up computed tomography angiography. Logistic regression was used to provide adjusted effect-size estimates. RESULTS Among 258 patients with MeVO, the median baseline National Institutes of Health Stroke Scale score was 7 (interquartile range: 5-12). A total of 72.1% (186/258) patients were treated with intravenous alteplase and in 41.8% (84/201), recanalization of the occlusion (revised arterial occlusive lesion score 2b/3) was seen on follow-up computed tomography angiography. Excellent functional outcome was achieved by 50.0% (129/258), and 67.4% (174/258) patients gained functional independence, while 8.9% (23/258) patients died within 90 days. Recanalization was observed in 21.4% (9/42) patients who were not treated with alteplase and 47.2% (75/159) patients treated with alteplase (P=0.003). Early recanalization (adjusted odds ratio, 2.29 [95% CI, 1.23-4.28]) was significantly associated with excellent functional outcome, while intravenous alteplase was not (adjusted odds ratio, 1.70 [95% CI, 0.88-3.25]). CONCLUSIONS One of every 2 patients with MeVO did not achieve excellent clinical outcome at 90 days with best medical management. Early recanalization was strongly associated with excellent outcome but occurred in <50% of patients despite intravenous alteplase treatment.
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Affiliation(s)
- Johanna M Ospel
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada.,Department of Radiology, University Hospital of Basel, Switzerland (J.M.O.)
| | - Bijoy K Menon
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada.,Department of Radiology (B.K.M., A.M.D., M.A.A., N.K., M.D.H., M.G.), University of Calgary, Canada.,Community Health Sciences (B.K.M., M.A.A., M.D.H.), University of Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada (B.K.M., A.M.D., M.A.A., M.D.H., M.G.)
| | - Andrew M Demchuk
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada.,Department of Radiology (B.K.M., A.M.D., M.A.A., N.K., M.D.H., M.G.), University of Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada (B.K.M., A.M.D., M.A.A., M.D.H., M.G.)
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada.,Department of Radiology (B.K.M., A.M.D., M.A.A., N.K., M.D.H., M.G.), University of Calgary, Canada.,Community Health Sciences (B.K.M., M.A.A., M.D.H.), University of Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada (B.K.M., A.M.D., M.A.A., M.D.H., M.G.)
| | - Nima Kashani
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada.,Department of Radiology (B.K.M., A.M.D., M.A.A., N.K., M.D.H., M.G.), University of Calgary, Canada
| | - Arnuv Mayank
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada
| | - Enrico Fainardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (E.F.)
| | | | - Alexander Khaw
- Department of Clinical Neurosciences, University of Western Ontario, London Health Sciences Centre, Canada (A.K.)
| | - Jai J Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Canada (J.J.S.)
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Institute & Ottawa Hospital Research Institute (D.D.)
| | - Josep Puig
- Department of Radiology, Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain (J.P.)
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (S.-I.S.)
| | - Seong H Ahn
- Department of Neurology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, South Korea (S.H.A.)
| | - Alexandre Poppe
- Department of Neurosciences, Université de Montréal, Canada (A.P.)
| | - Ana Calleja
- Department of Neurology, Hospital Clínico Universitario de Valladolid, University of Valladolid, Spain (A.C.)
| | - Michael D Hill
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada.,Department of Radiology (B.K.M., A.M.D., M.A.A., N.K., M.D.H., M.G.), University of Calgary, Canada.,Community Health Sciences (B.K.M., M.A.A., M.D.H.), University of Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada (B.K.M., A.M.D., M.A.A., M.D.H., M.G.)
| | - Mayank Goyal
- Department of Clinical Neurosciences (J.M.O., B.K.M., A.M.D., M.A.A., N.K., A.M., M.D.H., M.G.), University of Calgary, Canada.,Department of Radiology (B.K.M., A.M.D., M.A.A., N.K., M.D.H., M.G.), University of Calgary, Canada.,Hotchkiss Brain Institute, Calgary, Canada (B.K.M., A.M.D., M.A.A., M.D.H., M.G.)
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33
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Ciardi C, Cirio JJ, Scrivano EV, Bleise CD, Lylyk I, Lylyk P. Sex-Related Differences after Endovascular Treatment of Acute Ischemic Stroke in the 'Real World'. J Stroke Cerebrovasc Dis 2020; 29:105240. [PMID: 33066881 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gender differences are often reported in the field of ischemic stroke, although most of such discrepancies were observed in randomized trials involving highly selected populations. We therefore explored gender differences regarding 90-day outcomes in large vessel occlusion (LVO) strokes receiving endovascular treatment in a real world setting. METHODS This prospective registry included anterior and/or posterior circulation LVO strokes admitted between January 2014 and December 2019 who received mechanical thrombectomy up to 24 hours from symptoms onset or last known to be well. We explored sex-related differences in rates of functional independence (modified Rankin Scale, mRS, ≤2) at 90 days. Secondary outcomes included "National Institutes of Health Stroke Scale" (NIHSS) at 24 hours, successful reperfusion defined as modified Thrombolysis in Cerebral Infarction (mTICI) scale 2b/3, death, and symptomatic intracranial hemorrhage (sICH). RESULTS A total of 288 LVO stroke patients comprised the study population, involving 148 (51.4%) women. Females were older (71.4±15.7 vs. 66.1±14.0 years, p=0.003) and had lower rates of coronary artery disease (15% vs. 24%, p=0.05). The median time from symptoms onset to hospital arrival was 315 min (IQR 139.5-495.0) in females and 255.0 (IQR 117.0-405.0) in males (p=0.052). Rates of mRS ≤2 at 90 days were comparable (females 46% vs. males 49%, p=0.50). Successful reperfusion was achieved in 82% of females and 89% of males (p=0.10). Rates of sICH (females 10% vs. males 13%, p=0.47) and death (females 18% vs. males 21%, p=0.50) at 90 days were similar. NIHSS at 24 hours was the strongest predictor of functional independence at 90 days (area under ROC curve 0.92 (95%CI 0.87; 0.95)]. CONCLUSIONS Our prospective registry involving a real world setting suggests that females are equally likely to achieve good outcomes after endovascular treatment despite being older and having delayed hospital arrival compared to males. In addition, we found that NIHSS at 24 hours was the strongest predictor of functional independence at 90 days, sICH, and death.
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Affiliation(s)
- Celina Ciardi
- Department of Vascular Neurology, Stroke Unit. Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina.
| | - Juan J Cirio
- Department of Vascular Neurology, Stroke Unit. Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Esteban V Scrivano
- Department of Interventional Neuroradiology. Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Carlos D Bleise
- Department of Interventional Neuroradiology. Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Ivan Lylyk
- Department of Interventional Neuroradiology. Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Pedro Lylyk
- Department of Interventional Neuroradiology. Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina
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34
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Diferencias de género en la calidad de vida a largo plazo tras un ictus: influencia del estado funcional y el estado de ánimo. Neurologia 2020; 35:470-478. [DOI: 10.1016/j.nrl.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022] Open
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35
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López Espuela F, Portilla Cuenca J, Leno Díaz C, Párraga Sánchez J, Gamez-Leyva G, Casado Naranjo I. Sex differences in long-term quality of life after stroke: influence of mood and functional status. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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36
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Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, De Vries GJ, Epperson CN, Govindan R, Klein SL, Lonardo A, Maki PM, McCullough LD, Regitz-Zagrosek V, Regensteiner JG, Rubin JB, Sandberg K, Suzuki A. Sex and gender: modifiers of health, disease, and medicine. Lancet 2020; 396:565-582. [PMID: 32828189 PMCID: PMC7440877 DOI: 10.1016/s0140-6736(20)31561-0] [Citation(s) in RCA: 919] [Impact Index Per Article: 229.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/09/2023]
Abstract
Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.
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Affiliation(s)
- Franck Mauvais-Jarvis
- Diabetes Discovery & Sex-Based Medicine Laboratory, Section of Endocrinology, John W Deming Department of Medicine, Tulane University School of Medicine and Southeast Louisiana Veterans Health Care System Medical Center, New Orleans, LA, USA.
| | - Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Peter J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Roberta D Brinton
- Department of Pharmacology and Department of Neurology, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, USA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics and Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dawn L DeMeo
- Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Geert J De Vries
- Neuroscience Institute and Department of Biology, Georgia State University, Atlanta, GA, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Sabra L Klein
- W Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amedeo Lonardo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Pauline M Maki
- Department of Psychiatry, Department of Psychology, and Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiology, University Hospital Zürich, University of Zürich, Switzerland
| | - Judith G Regensteiner
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua B Rubin
- Department of Medicine, Department of Paediatrics, and Department of Neuroscience, Washington University School of Medicine St Louis, MO, USA
| | - Kathryn Sandberg
- Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University, Washington, DC, USA
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
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Rajashekar D, Wilms M, Hecker KG, Hill MD, Dukelow S, Fiehler J, Forkert ND. The Impact of Covariates in Voxel-Wise Lesion-Symptom Mapping. Front Neurol 2020; 11:854. [PMID: 32922356 PMCID: PMC7456820 DOI: 10.3389/fneur.2020.00854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Voxel-wise lesion-symptom mapping (VLSM) is a statistical technique to infer the structure-function relationship in patients with cerebral strokes. Previous VLSM research suggests that it is important to adjust for various confounders such as lesion size to minimize the inflation of true effects. The aim of this work is to investigate the regional impact of covariates on true effects in VLSM. Methods: A total of 222 follow-up datasets of acute ischemic stroke patients with known NIH Stroke Scale (NIHSS) score at 48-h post-stroke were available for this study. Patient age, lesion volume, and follow-up imaging time were tested for multicollinearity using variance inflation factor analysis and used as covariates in VLSM analyses. Covariate importance maps were computed from the VLSM results by standardizing the beta coefficients of general linear models. Results: Covariates were found to have distinct regional importance with respect to lesion eloquence in the brain. Age has a relatively higher importance in the superior temporal gyrus, inferior parietal lobule, and in the pre- and post-central gyri. Volume explains more variability in the opercular area of the insula, inferior frontal gyrus, and caudate. Follow-up imaging time accounts for most of the variance in the globus pallidus, ventromedial- and dorsolateral putamen, dorsal caudate, pre-motor thalamus, and the dorsal insula. Conclusions: This is the first study investigating and revealing distinctive regional patterns of importance for covariates typically used in VLSM. These covariate importance maps can improve our understanding of the lesion-deficit relationships in patients and could prove valuable for patient-specific treatment and rehabilitation planning.
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Affiliation(s)
- Deepthi Rajashekar
- Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Matthias Wilms
- Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kent G Hecker
- Departments of Community Health Sciences and Veterinary Clinical, and Diagnostic Sciences, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Sean Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Hawe RL, Cluff T, Dowlatshahi D, Hill MD, Dukelow SP. Assessment of Sex Differences in Recovery of Motor and Sensory Impairments Poststroke. Neurorehabil Neural Repair 2020; 34:746-757. [PMID: 32672513 DOI: 10.1177/1545968320935811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Understanding potential sex differences in stroke recovery is important for prognosis, ensuring appropriate allocation of health care resources, and for stratification in research studies. Previously, functional measures have shown poorer outcomes for females, however, little is known about sex differences that may exist in specific motor and sensory impairments. Objective. The aim of this study was to utilize robotic assessments of motor and sensory impairments to determine if there are sex differences at the impairment level in stroke recovery over the first 6 months poststroke. Methods. We used robotic and clinical assessments of motor and sensory impairments at 1, 6, 12, and 26 weeks poststroke in 108 males and 52 females. Linear mixed models were used to examine the effect of sex on recovery poststroke, controlling for age and lesion volume. Results. In general, we did not find significant sex differences across a range of assessments. The exception to this was a sex × age interaction for the Purdue Pegboard Assessment, where we found that females had better performance than males at younger ages (<62 years), but males had better performance at older ages. Conclusions. While recruitment biases need to be acknowledged when generalizing our results to stroke recovery at-large, our results suggest that sex differences do not exist at the impairment level poststroke.
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Affiliation(s)
- Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Cluff
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Abstract
BACKGROUND In 2009, the window from symptom onset to administration of tissue plasminogen activator for acute ischemic stroke was extended from 3 to 4.5 hours. Yet no systematic review has addressed prehospital delay by sex for stroke symptoms since this change. PURPOSE We aimed to (1) compare prehospital delay times-the time from symptom onset to hospital arrival-between women and men with acute stroke or transient ischemic attack and (2) summarize factors influencing prehospital delay by sex. METHODS The CINAHL, MEDLINE, PubMed, Scopus, and PsycINFO databases were searched using PRISMA guidelines. Inclusion criteria were as follows: (1) quantitative research articles published between May 2008 and April 2019, (2) investigation of prehospital delay among women and men 15 years or older who were given a diagnosis of acute stroke or transient ischemic attack, and (3) English-language publications. The Crowe Critical Appraisal Tool was used to evaluate the quality of studies. RESULTS Fifteen publications (n = 162 856) met inclusion criteria. Most studies (n = 11) showed no sex differences in prehospital delay. Four studies from Asian-Pacific countries and the United States showed that women had significantly longer prehospital delay compared with men. Older age, minority race/ethnicity (black and Mexican American), and underuse of emergency medical services were associated with prolonged prehospital delay in women. CONCLUSIONS Most study authors found no differences in prehospital delay between women and men; however, women delayed longer in some Asian-Pacific and American studies. Findings of sex differences were inconclusive.
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Ahnstedt H, Patrizz A, Chauhan A, Roy-O’Reilly M, Furr JW, Spychala MS, D’Aigle J, Blixt FW, Zhu L, Alegria JB, McCullough LD. Sex differences in T cell immune responses, gut permeability and outcome after ischemic stroke in aged mice. Brain Behav Immun 2020; 87:556-567. [PMID: 32058038 PMCID: PMC7590503 DOI: 10.1016/j.bbi.2020.02.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Stroke is a disease that presents with well-known sex differences. While women account for more stroke deaths, recent data show that after adjusting for age and pre-stroke functional status, mortality is higher in men. Immune responses are key determinants of stroke outcome and may differ by sex. This study examined sex differences in central and peripheral T cell immune responses, systemic effects on gut permeability and microbiota diversity and behavioral outcomes after stroke in aged mice. We hypothesized that there are sex differences in the immune response to stroke in aged animals. METHODS C57BL/6CR mice (20-22 months) were subjected to 60 min middle cerebral artery occlusion, or sham surgery. T cells were quantified in brain and blood at 3, 7 and 15 days (d) post-stroke by flow cytometry. Peripheral effects on gut permeability and microbiota diversity, as well as neurological function were assessed up to 14 d, and at 21 d (cognitive function) post-stroke. Brain glial fibrillary acidic protein (GFAP) expression was evaluated at 42 d post-stroke. RESULTS AND DISCUSSION Mortality (50% vs 14%, p < 0.05) and hemorrhagic transformation (44% vs 0%) were significantly higher in males than in females. No difference in infarct size at 3d were observed. Peripherally, stroke induced greater gut permeability of FITC-dextran in males at d3 (p < 0.05), and non-reversible alterations in microbiota diversity in males. Following the sub-acute phase, both sexes demonstrated a time-dependent increase of CD4+ and CD8+ T cells in the brain, with significantly higher levels of CD8+ T cells and Regulatory T cells in males at d15 (p < 0.01). Aged males demonstrated greater neurological deficits up to d5 and impaired sensorimotor function up to d15 when assessed by the corner asymmetry test (p < 0.001 and p < 0.01, respectively). A trend in greater cognitive decline was observed at d21 in males. Increased GFAP expression in the ischemic hemisphere, indicating astroglial activation and gliosis, was demonstrated in both males and females 42d post-stroke. Our findings indicate that despite a similar initial ischemic brain injury, aged male mice experience greater peripheral effects on the gut and ongoing central neuroinflammation past the sub-acute phase after stroke.
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Affiliation(s)
- Hilda Ahnstedt
- BRAINS Research Laboratory, Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
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The Impact of One's Sex and Social Living Situation on Rehabilitation Outcomes After a Stroke. Am J Phys Med Rehabil 2020; 99:48-55. [PMID: 31343498 DOI: 10.1097/phm.0000000000001276] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. DESIGN A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ≥5 and <5, was the primary outcome measure. A two-step generalized linear mixed model was used to measure the effect of sex on each functional independence measure item while controlling for many clinical and sociodemographic covariates. RESULTS After adjusting for sociodemographic and clinical factors, females had higher odds of reaching a supervision level for 14 of 18 functional independence measure items. Males had higher odds of reaching a supervision level on 2 of 18 functional independence measure items. Individuals who lived alone before their stroke had higher odds of reaching a supervision level than individuals who lived with a caregiver or with family for all functional independence measure items. CONCLUSIONS When sociodemographic and clinical factors are controlled, females are more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who live alone before their stroke have higher odds of discharging at a supervision level or better.
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Abstract
PURPOSE OF REVIEW This article reviews sex differences in stroke risk and presentation, with a particular emphasis on the unique risk factors women experience throughout the lifespan. RECENT FINDINGS Although prior studies suggested women have worse outcomes after stroke, it is now clear that age, prestroke functional status, and comorbidities explain many of the differences between men and women in stroke severity, functional outcomes, and mortality. Several meta-analyses and large cohort studies have evaluated the risk factors for women related to reproductive factors and found that fewer years between menarche and menopause, pregnancy complications (preeclampsia/eclampsia, preterm delivery, and stillbirth), oophorectomy, hormone replacement therapy use, and younger age at menopause all increase the risk of stroke. Although the nonreproductive risks of stroke overlap between men and women, those with greater impact on women include age, hypertension, atrial fibrillation, socioeconomic status, and depression. SUMMARY Significant sex differences are observed in risk factors of stroke and stroke outcome. Including this information in the clinical assessment of the individual patient may support development of more effective prevention plans.
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Abstract
ABSTRACT:Background:Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation.Methods:Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination.Results:Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40–80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10−4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10−13). Further, male patients (p = 6.4 × 10−7) and those < 65 years (p = 1.4 × 10−23) were more likely to be discharged home without homecare.Conclusion:There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.
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Scrutinio D, Battista P, Guida P, Lanzillo B, Tortelli R. Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke. Front Neurol 2020; 11:84. [PMID: 32132967 PMCID: PMC7040356 DOI: 10.3389/fneur.2020.00084] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023] Open
Abstract
Objective: We sought to determine sex differences in outcomes in patients with severe stroke who had been admitted to inpatient rehabilitation. Methods: We studied 1,316 patients aged 18 to 99 (mean 72) classified as case-mix groups 0108, 0109, and 0110 of the Medicare case-mix classification system. These groups encompass the most severe strokes. Three outcomes were analyzed: (1) 3-year mortality from admission to rehabilitation; (2) combined outcome of transfer to acute care or death within 90 days from admission to rehabilitation; (3) functional outcome, including proportional recovery in motor functioning and good functional outcome as defined by achievement of a Functional Independence Measure (FIM)-motor score ≥65 points at discharge. Multivariable regression analyses were used to assess sex-difference in each outcome between women and men. The covariates examined included age, marital status, comorbidities, time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission. Results: Kaplan-Meier estimated 3-year mortality rate was 20.7% in women and 22.0% in men. The crude hazard ratio (HR) of death for women compared with men was 0.94 (95% CI 0.74-1.20). After adjustment for significant covariates, the HR of 3-year mortality was 0.73 (95% CIs 0.56-0.96; p = 0.025). Comorbidity, including diabetes, anemia, coronary artery disease, atrial fibrillation, and chronic obstructive pulmonary disease, significantly increased mortality risk by 49-88%. The incidence of the combined outcome was 8.3% in women and 8.4% in men. The crude HR of the combined end-point for women compared with men was 1.05 (95% CI 0.72-1.53). After adjustment for significant covariates, the HR was 0.95 (95% CIs 0.65-1.40; p = 0.810). Likewise, no significant difference in proportional recovery or in the rate of achievement of a good functional outcome between women and men was observed. Conclusion: Among patients admitted to inpatient rehabilitation after severe stroke, women and men had comparable crude mortality rates at 3 years. After multivariable adjustment, however, women had lower mortality risk. No sex-differences in the risk of being transferred to acute care or dying within 90 days from admission to rehabilitation or in responsiveness to rehabilitation were observed.
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Affiliation(s)
- Domenico Scrutinio
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Petronilla Battista
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Pietro Guida
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Bernardo Lanzillo
- Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Rosanna Tortelli
- Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, London, United Kingdom
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45
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Sex Differences in Care Need and Survival in Patients Admitted to Nursing Home Poststroke. Can J Neurol Sci 2020; 47:153-159. [PMID: 31987059 DOI: 10.1017/cjn.2019.335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Women are more likely to be admitted to nursing home after stroke than men. Differences in patient characteristics and outcomes by sex after institutionalization are less understood. We examined sex differences in the characteristics and care needs of patients admitted to nursing home following stroke and their subsequent survival. METHODS We identified patients with stroke newly admitted to nursing home between April 2011 and March 2016 in Ontario, Canada, with follow-up until March 2018 using linked administrative data. We calculated prevalence ratios and 95% confidence intervals (CIs) for the primary outcomes of dependence for activities of daily living, cognitive impairment, frailty, health instability, and symptoms of depression or pain, comparing women to men. The secondary outcome was all-cause mortality. RESULTS Among 4831 patients, 60.9% were women. Compared to men, women were older (median age [interquartile range, IQR]: 84 [78, 89] vs. 80 [71, 86]), more likely to be frail (prevalence ratio 1.14, 95% CI [1.08, 1.19]), have unstable health (1.45 [1.28, 1.66]), and experience symptoms of depression (1.25 [1.11, 1.40]) or pain (1.21 [1.13, 1.30]), and less likely to have aggressive behaviors (0.87 [0.80, 0.94]). Overall median survival was 2.9 years. In a propensity-score-matched cohort, women had lower mortality than men (hazard ratio 0.85, 95% CI [0.77, 0.94]), but in the age-stratified survival analysis, the survival advantage in women was limited to those aged 75 years and older. CONCLUSIONS Despite lower subsequent mortality, women admitted to nursing home after stroke required more care than men. Pain and depression are two treatable symptoms that disproportionately affect women.
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Bereznyakova O, Dewar B, Dowlatshahi D, Howard V, Hamel C, Gocan S, Fedyk M, Shamy M. Benefit of carotid revascularisation for women with symptomatic carotid stenosis: protocol for a systematic review. BMJ Open 2019; 9:e032140. [PMID: 31719088 PMCID: PMC6858193 DOI: 10.1136/bmjopen-2019-032140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/29/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Carotid intervention in the form of endarterectomy or stenting is the current standard of care for the majority of patients with symptomatic high-grade carotid stenosis. However, some randomised controlled trials (RCT) have demonstrated that women benefited significantly less from intervention than men. It is unclear if this is a true phenomenon or a study sampling artefact, as women were severely under-represented in all RCTs of carotid revascularisation. A systematic review is needed to summarise the existing data and to answer the question of whether a women-only trial for symptomatic patients with ipsilateral carotid stenosis is scientifically necessary and ethically permissible. METHODS AND ANALYSIS We will systematically search Medline, Embase, PubMed and the Cochrane libraries for all studies with data from RCTs that included women and compared either endarterectomy with stenting or revascularisation (by means of endarterectomy or stenting) with medical therapy in patients with symptomatic carotid stenosis. Search dates will be restricted to 1991-2018. Two reviewers will conduct screening search results, study selection, data extraction and quality assessment. We will include all studies reporting outcomes of interest. Planned subgroup analysis based on revascularisation technique, degree of stenosis and timing of intervention from the index event will be conducted with enough data. ETHICS AND DISSEMINATION This research is exempt of ethics approval as no primary data will be collected. The results will be published in peer-reviewed journals and disseminated through national and international-level conferences and scientific meetings. The result of this comprehensive review will provide useful information on whether further RCTs are required to study a women-only population with symptomatic carotid disease. PROSPERO REGISTRATION NUMBER CRD42019134967.
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Affiliation(s)
| | - Brian Dewar
- Neurology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Virginia Howard
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Candyce Hamel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sophia Gocan
- Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mark Fedyk
- Mount Allison University, Sackville, New Brunswick, Canada
| | - Michel Shamy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Goda T, Oyama N, Kitano T, Iwamoto T, Yamashita S, Takai H, Matsubara S, Uno M, Yagita Y. Factors Associated with Unsuccessful Recanalization in Mechanical Thrombectomy for Acute Ischemic Stroke. Cerebrovasc Dis Extra 2019; 9:107-113. [PMID: 31563915 PMCID: PMC6792430 DOI: 10.1159/000503001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Mechanical thrombectomy (MT) for acute ischemic stroke has become a standard therapy, and the recanalization rate has significantly improved. However, some cases of unsuccessful recanalization still occur. We aimed to clarify patient factors associated with unsuccessful recanalization after MT for acute ischemic stroke. Methods This was a single-center, retrospective study of 119 consecutive patients with anterior circulation acute ischemic stroke who underwent MT at our hospital between April 2015 and March 2019. Successful recanalization after MT was defined as modified Treatment in Cerebral Ischemia (mTICI) grade 2b or 3, and unsuccessful recanalization was defined as mTICI grades 0–2a. Several factors were analyzed to assess their effect on recanalization rates. Results Successful recanalization was achieved in 88 patients (73.9%). The univariate analysis showed that female sex (38.6 vs. 67.7%, p = 0.007), a history of hypertension (53.4 vs. 83.9%, p = 0.003), and a longer time from groin puncture to recanalization (median 75 vs. 124 min, p < 0.001) were significantly associated with unsuccessful recanalization. The multivariate analysis confirmed that female sex (OR 3.18; 95% CI 1.12–9.02, p = 0.030), a history of hypertension (OR 4.84; 95% CI 1.32–17.8, p = 0.018), M2–3 occlusion (OR 4.26; 95% CI 1.36–13.3, p = 0.013), and the time from groin puncture to recanalization (per 10-min increase, OR 1.22; 95% CI 1.09–1.37, p < 0.001) were independently associated with unsuccessful recanalization. Conclusion Female sex and a history of hypertension might be predictors of unsuccessful recanalization after MT for anterior circulation acute ischemic stroke. Further studies are needed to fully evaluate predictors of recanalization.
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Affiliation(s)
- Toshiaki Goda
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan,
| | - Naoki Oyama
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
| | - Takaya Kitano
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.,Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takanori Iwamoto
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
| | - Shinji Yamashita
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
| | - Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
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Chalos V, de Ridder IR, Lingsma HF, Brown S, van Oostenbrugge RJ, Goyal M, Campbell BCV, Muir KW, Guillemin F, Bracard S, White P, Dávalos A, Jovin TG, Hill MD, Mitchell PJ, Demchuk AM, Saver JL, van Zwam WH, Dippel DWJ. Does Sex Modify the Effect of Endovascular Treatment for Ischemic Stroke? Stroke 2019; 50:2413-2419. [PMID: 31412753 PMCID: PMC6727933 DOI: 10.1161/strokeaha.118.023743] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text. Previous studies have reported less favorable outcome and less effect of endovascular treatment (EVT) after ischemic stroke in women than in men. Our aim was to study the influence of sex on outcome and on the effect of EVT for ischemic stroke in recent randomized trials on EVT.
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Affiliation(s)
- Vicky Chalos
- From the Department of Neurology, Erasmus MC University Medical Center the Netherlands (V.C., D.W.J.D.).,Department of Public Health, Erasmus MC University Medical Center the Netherlands (V.C., H.F.L.).,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center the Netherlands (V.C.)
| | - Inger R de Ridder
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (I.R.d.R., R.J.v.O.)
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center the Netherlands (V.C., H.F.L.)
| | - Scott Brown
- Altair Biostatistics, St. Louis Park, MN (S.B.).,Department of Diagnostic and Interventional Neuroradiology (S.B.)
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (I.R.d.R., R.J.v.O.)
| | - Mayank Goyal
- Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Canada (M.G., M.D.H., A.M.D.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Australia (B.C.V.C.)
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.)
| | - Francis Guillemin
- Department of Clinical Epidemiology, Inserm, University of Lorraine and University Hospital of Nancy, France (F.G.)
| | - Serge Bracard
- Altair Biostatistics, St. Louis Park, MN (S.B.).,Department of Diagnostic and Interventional Neuroradiology (S.B.)
| | - Philip White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (P.W.)
| | - Antoni Dávalos
- Department of Neuroscience, Hospital Germans Trias y Pujol, Barcelona, Spain (A.D.)
| | - Tudor G Jovin
- Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center Stroke Institute, Presbyterian University Hospital, PA (T.G.J.)
| | - Michael D Hill
- Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Canada (M.G., M.D.H., A.M.D.)
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Australia (P.J.M.)
| | - Andrew M Demchuk
- Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Canada (M.G., M.D.H., A.M.D.)
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of Los Angeles, CA (J.L.S.)
| | - Wim H van Zwam
- Department of Radiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (W.H.v.Z.)
| | - Diederik W J Dippel
- From the Department of Neurology, Erasmus MC University Medical Center the Netherlands (V.C., D.W.J.D.)
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Sheth SA, Lee S, Warach SJ, Gralla J, Jahan R, Goyal M, Nogueira RG, Zaidat OO, Pereira VM, Siddiqui A, Lutsep H, Liebeskind DS, McCullough LD, Saver JL. Sex Differences in Outcome After Endovascular Stroke Therapy for Acute Ischemic Stroke. Stroke 2019; 50:2420-2427. [PMID: 31412752 DOI: 10.1161/strokeaha.118.023867] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background and Purpose- We determined the effect of sex on outcome after endovascular stroke thrombectomy in acute ischemic stroke, including lifelong disability outcomes. Methods- We analyzed patients treated with the Solitaire stent retriever in the combined SWIFT (Solitaire FR With the Intention for Thrombectomy), STAR (Solitaire FR Thrombectomy for Acute Revascularization), and SWIFT PRIME (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment) cohorts. Ordinal and logistic regression were used to examine known factors influencing outcome after endovascular stroke thrombectomy and study the effect of sex on the association between these factors and outcomes, including age and time to reperfusion. Years of optimal life after thrombectomy were defined as disability-adjusted life years and calculated by projecting disability through adjusted poststroke life expectancy by sex. Results- Among 389 patients treated with endovascular stroke thrombectomy, 55% were females, and median National Institutes of Health Stroke Scale was 17 (interquartile range, 8-28). There were no differences between females versus males in presenting deficit severity (National Institutes of Health Stroke Scale score, 17 versus 17, P=0.21), occlusion location (69% versus 64% M1, P=0.62), presenting infarct extent (Alberta Stroke Program Early CT Score 8 versus 8, P=0.24), rate of substantial reperfusion (Thrombolysis in Cerebral Infarction 2b/3, 87% versus 83%, P=0.37), onset to reperfusion time (294 versus 302 minutes, P=0.46). Despite older ages (69 versus 64, P<0.001) and higher rate of atrial fibrillation (45% versus 30%, P=0.002) for females compared with males, adjusted rates of functional independence at 90 days were similar (odds ratio, 1.0; 95% CI, 0.6-1.6). After adjusting for age at presentation and stroke severity, females had more years of optimal life (disability-adjusted life year) after endovascular stroke thrombectomy, 10.6 versus 8.5 years (P<0.001). Conclusions- Despite greater age and higher rate of atrial fibrillation, females experienced comparable functional outcomes and greater years of optimal life after intervention compared with males.
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Affiliation(s)
- Sunil A Sheth
- From the Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston (S.A.S., S.L., L.D.M.)
| | - Songmi Lee
- From the Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston (S.A.S., S.L., L.D.M.)
| | - Steven J Warach
- Department of Neurology, Dell School of Medicine, University of Texas at Austin (S.J.W.)
| | - Jan Gralla
- Department of Neuroradiology, Inselspital, University Hospital, Berne, Switzerland (J.G.)
| | - Reza Jahan
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Santa Monica (R.J.)
| | - Mayank Goyal
- Department of Radiology and Clinical Neurosciences, University of Calgary, AB, Canada (M.G.)
| | - Raul G Nogueira
- Department of Neurology, Emory School of Medicine, Atlanta, GA (R.G.N.)
| | - Osama O Zaidat
- Department of Neurosurgery, Mercy Health, Toledo, OH (O.O.Z.)
| | - Vitor M Pereira
- Department of Medical Imaging, Toronto Western Hospital, ON, Canada (V.M.P.)
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY (A.S.)
| | - Helmi Lutsep
- Department of Neurology, Oregon Health and Science University, Portland (H.L.)
| | - David S Liebeskind
- Department of Neurology, Ronald Reagan UCLA Medical Center, Santa Monica (D.S.L., J.L.S.)
| | - Louise D McCullough
- From the Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston (S.A.S., S.L., L.D.M.)
| | - Jeffrey L Saver
- Department of Neurology, Ronald Reagan UCLA Medical Center, Santa Monica (D.S.L., J.L.S.)
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50
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Bushnell CD, Chaturvedi S, Gage KR, Herson PS, Hurn PD, Jiménez MC, Kittner SJ, Madsen TE, McCullough LD, McDermott M, Reeves MJ, Rundek T. Sex differences in stroke: Challenges and opportunities. J Cereb Blood Flow Metab 2018; 38:2179-2191. [PMID: 30114967 PMCID: PMC6282222 DOI: 10.1177/0271678x18793324] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/25/2018] [Accepted: 06/19/2018] [Indexed: 12/19/2022]
Abstract
Biologic sex influences many variables that are important to brain health in general, and to stroke or cerebral ischemia in particular, such as general health status, cerebrovascular anatomy and function, unique risk factors such as pregnancy and preeclampsia, symptomatology, and therapeutic response. A more complete understanding of the scale and depth of sexual dimorphism in the brain and the role of more general sex-based factors is crucial to reducing the burden of stroke in women and men. This focused review highlights recent findings in stroke, including sex differences in epidemiology, risk factor reduction, comparative use of stroke therapeutics in both sexes, the importance of frailty in women, and the biologic basis for sex differences in stroke. Such findings show tremendous promise for the future of personalized medicine in stroke prevention and treatment.
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Affiliation(s)
| | - Seemant Chaturvedi
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kathy R Gage
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Paco S Herson
- Department of Anesthesiology, University of Colorado, Denver, CO, USA
| | - Patricia D Hurn
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Monik C Jiménez
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Steven J Kittner
- Baltimore Veterans Administration Medical Center and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, Lansing, MI, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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