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Canavero I, Storti B, Marinoni G, De Souza DA, Moro E, Gatti L, Sacco S, Lorenzano S, Sandset EC, Poggesi A, Carrozzini T, Pollaci G, Potenza A, Gorla G, Wardlaw JM, Zedde ML, Bersano A. COVID-19 and stroke in women: impact on clinical, psychosocial and research aspects. Neurol Sci 2024:10.1007/s10072-024-07716-0. [PMID: 39103735 DOI: 10.1007/s10072-024-07716-0] [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: 06/24/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
Despite the growing interest in gender medicine, the influence of sex and gender on human diseases, including stroke, continues to be underestimated and understudied. The COVID-19 pandemic has overall impacted not only the occurrence and management of stroke but has also exacerbated sex and gender disparities among both patients and healthcare providers. This paper aims to provide an updated overview on the influence of sex and gender in stroke pathophysiology and care during COVID-19 pandemic, through biological, clinical, psychosocial and research perspectives. Gender equity and awareness of the importance of sexual differences are sorely needed, especially in times of health crisis but have not yet been achieved to date. To this purpose, the sudden yet worldwide diffusion of COVID-19 represents a unique learning experience that highlights critical unmet needs also in gender medicine. The failures of this recent past should be kept as food for thought to inspire proper strategies reducing inequalities and to address women's health and wellbeing issues, particularly in case of future pandemics.
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Affiliation(s)
- Isabella Canavero
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Giulia Marinoni
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Diana Aguiar De Souza
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHULN, University of Lisbon, Lisbon, Portugal
| | - Elena Moro
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, Grenoble Alpes University, Grenoble, France
| | - Laura Gatti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Else C Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Anna Poggesi
- NEUROFARBA Department, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation, Florence, Italy
| | - Tatiana Carrozzini
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Giuliana Pollaci
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Antonella Potenza
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Gemma Gorla
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy.
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Qu HL, Sun XY, He C, Chen HS. Sex Differences in the Dual Antiplatelet Therapy Versus Alteplase for Patients with Minor Nondisabling Acute Ischemic Stroke: A Secondary Analysis of the ARAMIS Study. CNS Drugs 2024; 38:649-659. [PMID: 38806883 DOI: 10.1007/s40263-024-01096-x] [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] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND AND PURPOSE Sex is associated with clinical outcome in stroke. The present study aimed to determine the effect of sex on efficacy of dual antiplatelet (DAPT) versus alteplase in ischemic stroke based on Antiplatelet versus recombinant tissue plasminogen activator (R-tPA) for Acute Mild Ischemic Stroke (ARAMIS) trial. METHODS In this secondary analysis of the ARAMIS study, eligible patients aged 18 years or older with minor nondisabling stroke who received dual antiplatelet therapy or intravenous alteplase within 4.5 h of stroke onset were divided into two groups: men and women. The primary endpoint was an excellent functional outcome, defined as a modified Rankin Scale (mRS) 0-1 at 90 days. Binary logistic regression analyses and generalized linear models were used. RESULTS Of the 719 patients who completed the study, 31% (223) were women, and 69% (496) were men. There were no significant sex differences in excellent functional outcome (unadjusted p = 0.304 for men and p = 0.993 for women; adjusted p = 0.376 for men and p = 0.918 for women) and favorable functional outcome (mRS score of 0-2; unadjusted p = 0.968 for men and p = 0.881 for women; adjusted p = 0.824 for men and p = 0.881 for women). But for the secondary outcomes, compared with alteplase, DAPT was associated with a significantly decreased proportion of early neurological deterioration within 24 h in men {unadjusted odds ratio [OR] = 0.440 [95% confidence interval (CI), 0.221-0.878]; p = 0.020; adjusted OR = 0.436 [95% CI, 0.216-0.877]; p = 0.020}, but not in women [unadjusted OR = 0.636 (95% CI, 0.175-2.319), p = 0.490; adjusted OR = 0.687 (95% CI, 0.181-2.609), p = 0.581]. For the safety outcomes, compared with the DAPT group, alteplase was associated with a significantly increased proportion of any bleeding events in men [unadjusted OR = 3.110 (95% CI, 1.103-8.770); p = 0.032], but not in women [unadjusted OR = 5.333 (95% CI, 0.613-46.407), p = 0.129; adjusted OR = 5.394 (95% CI, 0.592-49.112), p = 0.135]. CONCLUSION Sex did not influence the effect of dual antiplatelet therapy versus intravenous alteplase in minor nondisabling stroke, but more early neurological deterioration and bleeding events occurred in men who received alteplase.
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Affiliation(s)
- Hui-Ling Qu
- Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, 110016, China
| | - Xiao-Yu Sun
- Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, 110016, China
| | - Chao He
- Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, 110016, China
| | - Hui-Sheng Chen
- Department of Neurology, The General Hospital of Northern Theater Command, Shenyang, 110016, China.
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Mavridis A, Reinholdsson M, Sunnerhagen KS, Abzhandadze T. Predictors of functional outcome after stroke: Sex differences in older individuals. J Am Geriatr Soc 2024; 72:2100-2110. [PMID: 38741476 DOI: 10.1111/jgs.18963] [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: 12/18/2023] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Sex differences in stroke are well documented, with females being older at onset, with more severe strokes and worse outcomes than males. Females receive less comprehensive stroke unit treatment. Similarly, older individuals receive poorer quality care than younger ones. There is limited research on sex differences in factors that impact 3-month poststroke functional outcome in people older than 80 years. METHODS This register-based and cross-sectional study analyzed data from two stroke quality registers in Sweden from 2014 through 2019. The study included patients aged ≥80 with a diagnosis of ischemic or hemorrhagic stroke. Sociodemographic features, prestroke condition, stroke severity on admission (National Institutes of Health Stroke Scale [NIHSS]), stroke unit care, rehabilitation plans, and 3-month poststroke functional outcome measured with the modified Rankin Scale were analyzed. Ordinal regression analyses stratified by sex were conducted to assess sex differences in factors that impact poststroke functional outcome 3 months after the stroke. RESULTS A total of 2245 patients were studied with the majority (59.2%) being females. Females experienced more severe strokes (NIHSS median 4 vs. 3, p = 0.01) and were older at stroke onset than males (87.0 vs. 85.4, p < 0.001). Females were also less independent prestroke (69.9% vs. 77.4%, p < 0.001) and a higher proportion of females lived alone (78.2% vs. 44.2%, p < 0.001). Males received intravenous thrombolysis more often than females (16.3% vs. 12.0%, p = 0.005). Regarding 3-month functional outcome, males benefited more from thrombolysis (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.83), whereas females benefited more from thrombectomy (OR 0.40, 95% CI 0.20-0.71). CONCLUSION Stroke care should be adapted to sex disparities in older individuals, while clinicians should be aware of these sex disparities. Further research could clarify the mechanisms behind these disparities and lead to a more personalized approach to stroke care of the older population.
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Affiliation(s)
- Anastasios Mavridis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Malin Reinholdsson
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
- Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pérez-Sánchez S, Barragán-Prieto A, Loscertales JB, Cabezas Rodríguez JA, Zapata-Arriaza E, Amaya Pascasio L, Hermosín Gómez A, Gamero García MÁ, Galeano B, Fernández J, Pardo Galiana B, Domínguez Mayoral A, Ainz Gómez L, Fernández Navarro J, Del Toro C, Medina M, de Torres R, Baena P, Moniche F, Valverde Moyano R, Martínez P, González A, Montaner J. Closing the Sex-Based Differences in Stroke Care: Insights from a Large Telestroke Network on Treatment and Postacute Management. Health Equity 2024; 8:301-306. [PMID: 39011077 PMCID: PMC11249131 DOI: 10.1089/heq.2023.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 07/17/2024] Open
Abstract
Background The evolution of ischemic stroke is different accordin'g to sex and is one of the main causes of death in women. Previous studies have shown that women are less likely to receive acute treatment, and stroke center type is an important predictor of door-to-needle times. We investigated whether women are attended in a similar way to men in the telestroke network with specialized stroke physicians. Methods A prospective registry of ischemic strokes recorded in the centralized Andalusian telestroke network was analyzed, focusing on sex differences. Demographic data, clinical characteristics, neuroimaging data, treatment intervals, follow-up visits, and clinical outcomes were collected. Results A total of 3009 suspected stroke patients were attended to in the telestroke network from 2019 to 2023, of which 42.74% were women. Women were older (p < 0.001) and less independent upon arrival (p = 0.006) than men. There was no difference in the treatment received or in the treatment time intervals between the groups. Importantly, there was no difference in modified Rankin scale scores at 3 months between sexes. At 3 months post-stroke follow-up, women had fewer imaging tests (p = 0.018) and fewer outpatient visits (p < 0.001) than men. Conclusions No significant difference between men and women has been found in the acute treatment of stroke in a large telestroke network. However, the same is not true for the follow-up and management of patients after the acute phase. This fact supports that strict adherence to protocols and specialization of care lead to equal care that avoids sex differences in stroke treatment and functional outcomes.
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Affiliation(s)
- Soledad Pérez-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Ana Barragán-Prieto
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Juan Bautista Loscertales
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Juan Antonio Cabezas Rodríguez
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Elena Zapata-Arriaza
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Miguel Ángel Gamero García
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Benito Galeano
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Javier Fernández
- Department of Neurology, Hospital Universitario Torrecárdenas, Almería, Spain
| | - Blanca Pardo Galiana
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Domínguez Mayoral
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Leire Ainz Gómez
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Cristina Del Toro
- Department of Neurology, Hospital Universitario Torrecárdenas, Almería, Spain
| | - Manuel Medina
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Reyes de Torres
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Pablo Baena
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Moniche
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Patricia Martínez
- Department of Neurology, Hospital Universitario Torrecárdenas, Almería, Spain
| | - Alejandro González
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Group, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
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Imeh-Nathaniel E, Imeh-Nathaniel S, Imeh-Nathaniel A, Coker-Ayo O, Kulkarni N, Nathaniel TI. Sex Differences in Severity and Risk Factors for Ischemic Stroke in Patients With Hyperlipidemia. Neurosci Insights 2024; 19:26331055241246745. [PMID: 38706531 PMCID: PMC11069268 DOI: 10.1177/26331055241246745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This study aims to determine sex differences in poststroke hypertriglyceridemia (serum triglyceride levels ⩾ 200 mg/dl) and high stroke severity in ischemic stroke patients. Method Our study analyzed data from 392 males and 373 females with hypertriglyceridemia. Stroke severity on admission was measured using the National Institute of Health Stroke Scale (NIHSS) with a value ⩽7 indicating a more favorable post-stroke prognosis while a score of >7 indicates poorer post-stroke outcomes. Logistic regression models adjusted for demographic and risk factors. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each clinical risk factor were used to predict the increasing odds of an association of a specific clinical baseline risk factor with the male or female AIS with hypertriglyceridemia. Results In the adjusted analysis, male patients with hypertriglyceridemia, diastolic blood pressure (OR = 1.100, 95% CI, 1.034-1.171, P = .002), and Ischemic stroke mortality (OR = 6.474, 95% CI, 3.262-12.847, P < .001) were significantly associated with increased stroke severity. In female patients with hypertriglyceridemia, age (OR = 0.920, 95% CI, 0.866-0.978, P = .008) was associated with reduced stroke severity, while ischemic stroke mortality score (OR = 37.477, 95% CI, 9.636-145.756, P < .001) was associated with increased stroke severity. Conclusion Increased ischemic stroke mortality risk score was associated with increased severity in both male and female AIS patients with hypertriglyceridemia. Our findings provide information about sex differences in specific risk factors that can be managed to improve the care of male and female ischemic stroke patients with hypertriglyceridemia.
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Affiliation(s)
| | | | | | | | | | - Thomas I Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
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Indraswari F, Yaghi S, Khan F. Sex specific outcomes after ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107754. [PMID: 38703877 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024] Open
Affiliation(s)
- Fransisca Indraswari
- Department of Neurology, Brown Medical School, Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA
| | - Shadi Yaghi
- Department of Neurology, Brown Medical School, Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA.
| | - Farhan Khan
- Department of Neurology, Brown Medical School, Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA
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Peycheva M, Padlina G, Genceviciute K, Krasteva MP, Boronylo A, Goeldlin MB, Müller M, Wenz ES, Müller MD, Hammer H, Bücke P, Bigi S, Simonetti BG, Hoffmann A, Umarova RM, Pilgram-Pastor S, Gralla J, Mordasini P, Antonenko K, Heldner MR. Baseline characteristics and outcome of stroke patients after endovascular therapy according to previous symptomatic vascular disease and sex. Front Neurol 2024; 15:1293905. [PMID: 38694775 PMCID: PMC11061446 DOI: 10.3389/fneur.2024.1293905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Aim The aim of this study was to investigate baseline characteristics and outcome of patients after endovascular therapy (EVT) for acute large vessel occlusion (LVO) in relation to their history of symptomatic vascular disease and sex. Methods Consecutive EVT-eligible patients with LVO in the anterior circulation admitted to our stroke center between 04/2015 and 04/2020 were included in this observational cohort study. All patients were treated according to a standardized acute ischaemic stroke (AIS) protocol. Baseline characteristics and successful reperfusion, recurrent/progressive in-hospital ischaemic stroke, symptomatic in-hospital intracranial hemorrhage, death at discharge and at 3 months, and functional outcome at 3 months were analyzed according to previous symptomatic vascular disease and sex. Results 995 patients with LVO in the anterior circulation (49.4% women, median age 76 years, median admission NIHSS score 14) were included. Patients with multiple vs. no previous vascular events showed higher mortality at discharge (20% vs. 9.3%, age/sex - adjustedOR = 1.43, p = 0.030) and less independency at 3 months (28.8% vs. 48.8%, age/sex - adjustedOR = 0.72, p = 0.020). All patients and men alone with one or multiple vs. patients and men with no previous vascular events showed more recurrent/progressive in-hospital ischaemic strokes (19.9% vs. 6.4% in all patients, age/sex - adjustedOR = 1.76, p = 0.028) (16.7% vs. 5.8% in men, age-adjustedOR = 2.20, p = 0.035). Men vs. women showed more in-hospital symptomatic intracranial hemorrhage among patients with one or multiple vs. no previous vascular events (23.7% vs. 6.6% in men and 15.4% vs. 5.5% in women, OR = 2.32, p = 0.035/age - adjustedOR = 2.36, p = 0.035). Conclusions Previous vascular events increased the risk of in-hospital complications and poorer outcome in the analyzed patients with EVT-eligible LVO-AIS. Our findings may support risk assessment in these stroke patients and could contribute to the design of future studies.
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Affiliation(s)
- Marieta Peycheva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology and Research Institute, Medical University Plovdiv, Plovdiv, Bulgaria
| | - Giovanna Padlina
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Clinica Luganese, Mancucco, Lugano, Switzerland
| | - Kotryna Genceviciute
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marina P. Krasteva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Queen Giovanna, Sofia, Bulgaria
| | - Anna Boronylo
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Madlaine Müller
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Elena S. Wenz
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mandy D. Müller
- Department of Neurosurgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sandra Bigi
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Paediatric Neurology, Department of Paediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Barbara Goeggel Simonetti
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Neuropaediatrics, Istituto Pediatrico della Svizzera Italiana IPSI EOC, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Angelika Hoffmann
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Roza M. Umarova
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sara Pilgram-Pastor
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Netzwerk Radiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Kim DJ, Singh N, Catanese L, Yu AYX, Demchuk AM, Lloret-Villas MI, Deschaintre Y, Coutts SB, Khosravani H, Appireddy R, Moreau F, Gubitz G, Tkach A, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Manosalva H, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Phillips S, Hill MD, Poppe AY, Ademola A, Shamy M, Bala F, Sajobi TT, Swartz RH, Almekhlafi MA, Menon BK, Field TS. Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase. Stroke 2024; 55:288-295. [PMID: 38174568 DOI: 10.1161/strokeaha.123.045320] [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: 08/14/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase). METHODS AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.25 mg/kg) with alteplase (0.9 mg/kg) in acute ischemic stroke within 4.5 hours of onset. In this post hoc analysis, baseline characteristics, workflow times, successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracerebral hemorrhage, 90-day functional independence (modified Rankin Scale score, 0-1), and 90-day mortality were compared by sex. Mixed-effects regression analysis was used adjusting for age, stroke severity, and occlusion site for outcomes. RESULTS Of 1577 patients treated with intravenous thrombolysis (2019-2022), 755 (47.9%) were women. Women were older (median, 77 [68-86] years in women versus 70 [59-79] years in men) and had a higher proportion of severe strokes (National Institutes of Health Stroke Scale score >15; 32.4% versus 24.9%) and large vessel occlusions (28.7% versus 21.5%) compared with men. All workflow times were comparable between sexes. Women were less likely to achieve functional independence (31.7% versus 39.8%; unadjusted relative risk, 0.80 [95% CI, 0.70-0.91]) and had higher mortality (17.7% versus 13.3%; unadjusted relative risk, 1.33 [95% CI, 1.06-1.69]). Adjusted analysis showed no difference in outcomes between sexes. CONCLUSIONS Differences in prognostic factors of age, stroke severity, and occlusion site largely accounted for higher functional dependence and mortality in women. No sex disparities were apparent in workflow quality indicators. Given the integration of the AcT trial into clinical practice, these results provide reassurance that no major sex biases are apparent in acute stroke management throughout participating Canadian centers. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Diana J Kim
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Nishita Singh
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | - Luciana Catanese
- Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Amy Y X Yu
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, QC, Canada (Y.D.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Houman Khosravani
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Queen's University, Kingston, ON, Canada (R.A.)
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | | | - Dar Dowlatshahi
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - George Medvedev
- Royal Columbian Hospital, New Westminster, BC, Canada (G.M.)
| | - Jennifer Mandzia
- London Health Sciences Centre, Western University, London, ON, Canada (J.M.)
| | | | - Jai Shankar
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | | | | | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, Canada (G.H.)
| | - Stephen Phillips
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Ayoola Ademola
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - Fouzi Bala
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Richard H Swartz
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.)
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9
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Dawson J, MacDonald A. Sex and hypertensive organ damage: stroke. J Hum Hypertens 2023; 37:644-648. [PMID: 37059829 PMCID: PMC10403348 DOI: 10.1038/s41371-023-00830-0] [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: 06/27/2022] [Revised: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
Stroke is a common cause of death and disability in both men and women. Differences in the incidence, presenting features and outcome after stroke have been reported between men and women. The global lifetime risk of stroke of approximately 25% is similar in men and women, although in women, the first cardiovascular event is more likely to be stroke than in men. Concerningly, there are reports of underuse of some treatments in women, although these differences may be diminishing over time. In addition, there are specific clinical challenges that can arise in women with stroke, such as stroke in people taking hormonal therapy, and stroke during pregnancy and stroke in the post-partum period. This review will cover these areas highlighting important differences and areas for future research. We found there are important differences in incidence of stroke, which differ by age. Further, there is concerning evidence that some treatments such as intravenous thrombolysis are underused in women. While there may be some differences in the relative effectiveness of treatments such as antiplatelet therapy and blood pressure reduction between men and women, for most aspects of stroke care, benefit is clear in both men and women and the emphasis must be on more equitable access. There is limited evidence to inform decision making during pregnancy and the post-partum period, but guidelines now exist and further research is needed in these areas.
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Affiliation(s)
- Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Alexander MacDonald
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
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10
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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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11
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Zhang X, Wang X, Wang S, Zhang Y, Wang Z, Yang Q, Wang S, Cao R, Yu B, Zheng Y, Dang Y. Machine learning algorithms assisted identification of post-stroke depression associated biological features. Front Neurosci 2023; 17:1146620. [PMID: 36968495 PMCID: PMC10030717 DOI: 10.3389/fnins.2023.1146620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesPost-stroke depression (PSD) is a common and serious psychiatric complication which hinders functional recovery and social participation of stroke patients. Stroke is characterized by dynamic changes in metabolism and hemodynamics, however, there is still a lack of metabolism-associated effective and reliable diagnostic markers and therapeutic targets for PSD. Our study was dedicated to the discovery of metabolism related diagnostic and therapeutic biomarkers for PSD.MethodsExpression profiles of GSE140275, GSE122709, and GSE180470 were obtained from GEO database. Differentially expressed genes (DEGs) were detected in GSE140275 and GSE122709. Functional enrichment analysis was performed for DEGs in GSE140275. Weighted gene co-expression network analysis (WGCNA) was constructed in GSE122709 to identify key module genes. Moreover, correlation analysis was performed to obtain metabolism related genes. Interaction analysis of key module genes, metabolism related genes, and DEGs in GSE122709 was performed to obtain candidate hub genes. Two machine learning algorithms, least absolute shrinkage and selection operator (LASSO) and random forest, were used to identify signature genes. Expression of signature genes was validated in GSE140275, GSE122709, and GSE180470. Gene set enrichment analysis (GSEA) was applied on signature genes. Based on signature genes, a nomogram model was constructed in our PSD cohort (27 PSD patients vs. 54 controls). ROC curves were performed for the estimation of its diagnostic value. Finally, correlation analysis between expression of signature genes and several clinical traits was performed.ResultsFunctional enrichment analysis indicated that DEGs in GSE140275 enriched in metabolism pathway. A total of 8,188 metabolism associated genes were identified by correlation analysis. WGCNA analysis was constructed to obtain 3,471 key module genes. A total of 557 candidate hub genes were identified by interaction analysis. Furthermore, two signature genes (SDHD and FERMT3) were selected using LASSO and random forest analysis. GSEA analysis found that two signature genes had major roles in depression. Subsequently, PSD cohort was collected for constructing a PSD diagnosis. Nomogram model showed good reliability and validity. AUC values of receiver operating characteristic (ROC) curve of SDHD and FERMT3 were 0.896 and 0.964. ROC curves showed that two signature genes played a significant role in diagnosis of PSD. Correlation analysis found that SDHD (r = 0.653, P < 0.001) and FERM3 (r = 0.728, P < 0.001) were positively related to the Hamilton Depression Rating Scale 17-item (HAMD) score.ConclusionA total of 557 metabolism associated candidate hub genes were obtained by interaction with DEGs in GSE122709, key modules genes, and metabolism related genes. Based on machine learning algorithms, two signature genes (SDHD and FERMT3) were identified, they were proved to be valuable therapeutic and diagnostic biomarkers for PSD. Early diagnosis and prevention of PSD were made possible by our findings.
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Affiliation(s)
- Xintong Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiangyu Wang
- Department of Rehabilitation Medicine, The Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Shuwei Wang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Yingjie Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zeyu Wang
- Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Qingyan Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Song Wang
- Department of Neurological Rehabilitation, Wuxi Yihe Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Risheng Cao
- Department of Science and Technology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Risheng Cao,
| | - Binbin Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Binbin Yu,
| | - Yu Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Yu Zheng,
| | - Yini Dang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- *Correspondence: Yini Dang,
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12
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Liu J, Sato Y, Falcone-Juengert J, Kurisu K, Shi J, Yenari MA. Sexual dimorphism in immune cell responses following stroke. Neurobiol Dis 2022; 172:105836. [PMID: 35932990 DOI: 10.1016/j.nbd.2022.105836] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/11/2022] [Accepted: 07/31/2022] [Indexed: 11/22/2022] Open
Abstract
Recent bodies of work in regard to stroke have revealed significant sex differences in terms of risk and outcome. While differences in sex hormones have been the focus of earlier research, the reasons for these differences are much more complex and require further identification. This review covers differences in sex related immune responses with a focus on differences in immune cell composition and function. While females are more susceptible to immune related diseases, they seem to have better outcomes from stroke at the experimental level with reduced pro-inflammatory responses. However, at the clinical level, the picture is much more complex with worse neurological outcomes from stroke. While the use of exogenous sex steroids can replicate some of these findings, it is apparent that many other factors are involved in the modulation of immune responses. As a result, more research is needed to better understand these differences and identify appropriate interventions and risk modification.
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Affiliation(s)
- Jialing Liu
- Dept Neurosurgery, UCSF and SF VAMC, San Francisco, CA, USA
| | - Yoshimichi Sato
- Dept Neurosurgery, UCSF and SF VAMC, San Francisco, CA, USA; Dept Neurosurgery, Tohoku University, Sendai, Japan
| | | | - Kota Kurisu
- Dept Neurosurgery, Hokkaido University, Sapporo, Japan
| | - Jian Shi
- Dept Neurology, UCSF and SF VAMC, San Francisco, CA, USA
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13
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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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14
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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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15
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Lee KO, Kwon I, Nam HS, Park Y, Kim J, Shim Y, Erdenebileg Z, Cha MJ, Choi HJ, Choi HY, Song JW, Heo JH. Effect of leukopenia induced by cyclophosphamide on the initial stage of arterial thrombosis in mice. Thromb Res 2021; 206:111-119. [PMID: 34455128 DOI: 10.1016/j.thromres.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/24/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Leukocytes are found in organizing thrombi and are associated with thrombus growth. However, their role in the initial stage of thrombus formation is not well known. We investigated the role of leukocytes in the early stage of arterial thrombosis by inducing leukopenia. METHODS In this double-blind, randomized, placebo-controlled study, 72 Institute of Cancer Research mice were randomly treated with intraperitoneal 100 mg/kg cyclophosphamide or normal saline. The primary outcome was time to occlusion after FeCl3 treatment. We also compared thrombus size, histological composition, and association with peripheral blood cell counts between cyclophosphamide and control groups. RESULTS Cyclophosphamide treatment significantly decreased leukocyte counts by 82.8% compared to placebo (P < 0.001). The time to occlusion was significantly longer in the cyclophosphamide group (3.31 ± 1.59 min) than in the control group (2.30 ± 1.14 min; P = 0.003). The immunoreactivity for Ly6G-positive cells, intracellular histone H3, and released histone H3 in thrombi was significantly reduced in the cyclophosphamide group by 92.8%, 50.2%, and 34.3%, respectively. Time to occlusion had a moderate negative correlation with leukocyte count in peripheral blood (r = -0.326, P = 0.022) in the entire group. CONCLUSIONS Cyclophosphamide-induced leukopenia attenuated thrombus formation during the early stage of arterial thrombosis. Our findings suggest the potential role of leukocytes in the initial stage of arterial thrombosis.
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Affiliation(s)
- Kee Ook Lee
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il Kwon
- Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea; Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youngseon Park
- Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Republic of Korea
| | - Jayoung Kim
- Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeseul Shim
- Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Republic of Korea
| | - Zolzaya Erdenebileg
- Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myoung Jin Cha
- Department of Neurology, National Police Hospital, Seoul, Republic of Korea
| | - Hyun-Jung Choi
- Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jae-Woo Song
- Department of Laboratory Medicine, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Republic of Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea; Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Republic of Korea.
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16
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Lettow I, Jensen M, Schlemm E, Boutitie F, Quandt F, Cheng B, Ebinger M, Endres M, Fiebach JB, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G. Serious Adverse Events and Their Impact on Functional Outcome in Acute Ischemic Stroke in the WAKE-UP Trial. Stroke 2021; 52:3768-3776. [PMID: 34433305 DOI: 10.1161/strokeaha.120.033425] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE During the first days and weeks after an acute ischemic stroke, patients are prone to complications that can influence further treatment, recovery, and functional outcome. In clinical trials, severe complications are recorded as serious adverse events (SAE). We analyzed the effect of SAE on functional outcome and predictors of SAE in the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke). METHODS We performed a post hoc analysis of WAKE-UP, a multicenter, randomized, placebo-controlled clinical trial of magnetic resonance imaging-guided intravenous thrombolysis with alteplase in patients with acute ischemic stroke and unknown time of onset. Functional outcome was assessed by the modified Rankin Scale 90 days after the stroke. SAE were reported to a central safety desk and recorded and categorized by organ system using Medical Dictionary for Regulatory Activities terminology. We used logistic regression analysis to determine the effect of SAE on functional outcome and linear multiple regression analysis to identify baseline predictors of SAE. RESULTS Among 503 patients randomized, 199 SAE were reported for n=110 (22%) patients. Of those patients who did suffer a SAE, 20 (10%) had a fatal outcome. Patients suffering from at least one SAE had a lower odds of reaching a favorable outcome (modified Rankin Scale score of 0-1) at 90 days (adjusted odds ratio, 0.36 [95% CI, 0.21-0.61], P<0.001). Higher age (P=0.04) and male sex (P=0.01) were predictors for the occurrence of SAE. CONCLUSIONS SAEs were observed in about one in 5 patients, were more frequent in elderly and male patients and were associated with worse functional outcome. These results may help to assess the risk of SAE in future stroke trials and create awareness for severe complications after stroke in clinical practice. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01525290 and https://eudract.ema.europa.eu; Unique identifier: 2011-005906-32.
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Affiliation(s)
- Iris Lettow
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (I.L., M.J., E.S., F.Q., B.C., C.G., G.T.)
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (I.L., M.J., E.S., F.Q., B.C., C.G., G.T.)
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (I.L., M.J., E.S., F.Q., B.C., C.G., G.T.)
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, France (F.B.)
| | - Fanny Quandt
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (I.L., M.J., E.S., F.Q., B.C., C.G., G.T.)
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (I.L., M.J., E.S., F.Q., B.C., C.G., G.T.)
| | - Martin Ebinger
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Germany (M. Ebinger).,entrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany (M. Ebinger, M. Endres, J.B.F.)
| | - Matthias Endres
- entrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany (M. Ebinger, M. Endres, J.B.F.).,Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (M. Endres)
| | - Jochen B Fiebach
- entrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany (M. Ebinger, M. Endres, J.B.F.)
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (V.T.).,Austin Health, Department of Neurology, Australia (V.T.)
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (R.L.).,KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Belgium (R.L.).,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Belgium (R.L.)
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom (K.W.M.)
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, France (N.N.)
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, Italysa (S.P.)
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.)
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (I.L., M.J., E.S., F.Q., B.C., C.G., G.T.)
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (I.L., M.J., E.S., F.Q., B.C., C.G., G.T.)
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Dmytriw AA, Ku JC, Yang VXD, Hui N, Uchida K, Morimoto T, Spears J, Marotta TR, Diestro JDB. Do Outcomes between Women and Men Differ after Endovascular Thrombectomy? A Meta-analysis. AJNR Am J Neuroradiol 2021; 42:910-915. [PMID: 33664109 DOI: 10.3174/ajnr.a7075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/25/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Research on the presence of sex-based differences in the outcomes of patients undergoing endovascular thrombectomy for acute ischemic stroke has reached differing conclusions. PURPOSE This review aimed to determine whether sex influences the outcome of patients with large-vessel occlusion stroke undergoing endovascular thrombectomy. STUDY SELECTION We performed a systematic review and meta-analysis of endovascular thrombectomy studies with either stratified cohort outcomes according to sex (females versus males) or effect size reported for the consequence of sex versus outcomes. We included 33 articles with 7335 patients. DATA ANALYSIS We pooled ORs for the 90-day mRS score, 90-day mortality, symptomatic intracranial hemorrhage, and recanalization. DATA SYNTHESIS Pooled 90-day good outcomes (mRS ≤ 2) were better for men than women (OR = 1.29; 95% CI, 1.09-1.53; P = <.001, I2 = 56.95%). The odds of the other outcomes, recanalization (OR = 0.94; 95% CI, 0.77-1.15; P = .38, I2 = 0%), 90-day mortality (OR = 1.11; 95% CI, 0.89-1.38; P = .093, I2 = 0%), and symptomatic intracranial hemorrhage (OR = 1.40; 95% CI, 0.99-1.99; P = .069, I2 = 0%) were comparable between men and women. LIMITATIONS Moderate heterogeneity was found. Most studies included were retrospective in nature. In addition, the randomized trials included were not specifically designed to compare outcomes between sexes. CONCLUSIONS Women undergoing endovascular thrombectomy for large-vessel occlusion have inferior 90-day clinical outcomes. Sex-specific outcomes should be investigated further in future trials as well as pathophysiologic studies.
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Affiliation(s)
- A A Dmytriw
- Department of Medical Imaging (A.A.D., T.R.M., J.D.B.D.), University of Toronto, Toronto, Ontario, Canada
| | - J C Ku
- Division of Neurosurgery (J.C.K., V.X.D.Y., J.S., T.R.M.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Division of Neurosurgery (J.C.K., V.X.D.Y., J.S., T.R.M.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - N Hui
- NeuroSpine Surgery Research Group (N.H.), The University of New South Wales, Sydney, New South Wales, Australia
| | - K Uchida
- Department of Clinical Epidemiology (K.U., T.M.), Hyogo College of Medicine, Nishinomiya, Japan
| | - T Morimoto
- Department of Clinical Epidemiology (K.U., T.M.), Hyogo College of Medicine, Nishinomiya, Japan
| | - J Spears
- Division of Neurosurgery (J.C.K., V.X.D.Y., J.S., T.R.M.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology (J.S., T.R.M., J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - T R Marotta
- Department of Medical Imaging (A.A.D., T.R.M., J.D.B.D.), University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery (J.C.K., V.X.D.Y., J.S., T.R.M.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology (J.S., T.R.M., J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J D B Diestro
- Department of Medical Imaging (A.A.D., T.R.M., J.D.B.D.), University of Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology (J.S., T.R.M., J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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18
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Yaghi S, Henninger N, Scher E, Giles J, Liu A, Nagy M, Kaushal A, Azher I, Mac Grory B, Fakhri H, Espaillat KB, Asad SD, Pasupuleti H, Martin H, Tan J, Veerasamy M, Liberman AL, Esenwa C, Cheng N, Moncrieffe K, Moeini-Naghani I, Siddu M, Trivedi T, Leon Guerrero CR, Khan M, Nouh A, Mistry E, Keyrouz S, Furie K. Early ischaemic and haemorrhagic complications after atrial fibrillation-related ischaemic stroke: analysis of the IAC study. J Neurol Neurosurg Psychiatry 2020; 91:750-755. [PMID: 32404380 PMCID: PMC8179007 DOI: 10.1136/jnnp-2020-323041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Predictors of long-term ischaemic and haemorrhagic complications in atrial fibrillation (AF) have been studied, but there are limited data on predictors of early ischaemic and haemorrhagic complications after AF-associated ischaemic stroke. We sought to determine these predictors. METHODS The Initiation of Anticoagulation after Cardioembolic stroke study is a multicentre retrospective study across that pooled data from consecutive patients with ischaemic stroke in the setting of AF from stroke registries across eight comprehensive stroke centres in the USA. The coprimary outcomes were recurrent ischaemic event (stroke/TIA/systemic arterial embolism) and delayed symptomatic intracranial haemorrhage (d-sICH) within 90 days. We performed univariate analyses and Cox regression analyses including important predictors on univariate analyses to determine independent predictors of early ischaemic events (stroke/TIA/systemic embolism) and d-sICH. RESULTS Out of 2084 patients, 1520 patients qualified; 104 patients (6.8%) had recurrent ischaemic events and 23 patients (1.5%) had d-sICH within 90 days from the index event. In Cox regression models, factors associated with a trend for recurrent ischaemic events were prior stroke or transient ischemic attack (TIA) (HR 1.42, 95% CI 0.96 to 2.10) and ipsilateral arterial stenosis with 50%-99% narrowing (HR 1.54, 95% CI 0.98 to 2.43). Those associated with sICH were male sex (HR 2.68, 95% CI 1.06 to 6.83), history of hyperlipidaemia (HR 2.91, 95% CI 1.08 to 7.84) and early haemorrhagic transformation (HR 5.35, 95% CI 2.22 to 12.92). CONCLUSION In patients with ischaemic stroke and AF, predictors of d-sICH are different than those of recurrent ischaemic events; therefore, recognising these predictors may help inform early stroke versus d-sICH prevention strategies.
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Affiliation(s)
- Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erica Scher
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - James Giles
- Department of Neurology, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Angela Liu
- Department of Neurology, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Muhammad Nagy
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ashutosh Kaushal
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Idrees Azher
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Brian Mac Grory
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Hiba Fakhri
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Syed Daniyal Asad
- Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA
| | | | - Heather Martin
- Department of Neurology, Spectrum Health, Grand Rapids, Michigan, USA
| | - Jose Tan
- Department of Neurology, Spectrum Health, Grand Rapids, Michigan, USA
| | | | - Ava L Liberman
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Charles Esenwa
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Natalie Cheng
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Khadean Moncrieffe
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Iman Moeini-Naghani
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Mithilesh Siddu
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Tushar Trivedi
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Christopher R Leon Guerrero
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Muhib Khan
- Department of Neurology, Spectrum Health, Grand Rapids, Michigan, USA.,Department of Neurology, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Amre Nouh
- Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA
| | - Eva Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Salah Keyrouz
- Department of Neurology, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Karen Furie
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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19
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Tate MJ, Shugart RM, Moraney RA, Brechtel LE, Blum B, Thomas I Nathaniel. Gender and functional outcomes in prestroke depressive patients treated with thrombolytic therapy. FUTURE NEUROLOGY 2020. [DOI: 10.2217/fnl-2019-0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim: This study investigated the clinical factors associated with functional ambulatory outcomes and gender differences in prestroke depressive patients. Materials & methods: Clinical risk factors associated with improved functional outcomes with recombinant tissue plasminogen activator-treated cohorts were determined using binary logistic regression. Results: In the adjusted analysis, improvement in ambulation was associated with male patients that had higher National Institute of Health stroke scale score (p = 0.04), a stroke history (p = 0.026), lower serum creatinine levels (p = 0.049) and were taking cholesterol reducing medication (p = 0.014). Improvement in females was associated with taking antidepressants (p = 0.027) and having lower National Institute of Health stroke scale score (p = 0.002). Conclusion: Our findings indicate gender disparities between male and female prestroke depressive patients.
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Affiliation(s)
- Mandy J Tate
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Rachel M Shugart
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Robyn A Moraney
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Leanne E Brechtel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Brice Blum
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
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20
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Abstract
Sex disparities within the field of stroke, including subarachnoid hemorrhages (SAHs), have been in focus during the last 2 decades. It is clear that stroke incidence is higher in men, and also that men have their first stroke earlier than women. On the other hand, women have more severe strokes, mainly because cardioembolic strokes are more common in women. This leads to higher case fatality and worse functional outcome in women. It has often been pointed out that women more often have nontraditional stroke symptoms, and therefore may seek medical help later. After discharge from the hospital, female stroke survivors live alone in many cases and are dependent on external care. Therefore, these women frequently rate their quality of life (QoL) lower than men do. Female spouses more often provide help to their male stroke survivors than the reverse, and they accept a heavier burden. These caregivers are at high risk for depression, low QoL, and low psychologic wellbeing. SAH is a special form of stroke, often caused by a ruptured aneurysm. It is about 20% more common in women. The case fatality is high, but does not differ between the sexes.
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Affiliation(s)
- Peter Appelros
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Signild Åsberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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21
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Rodríguez-Castro E, Rodríguez-Yáñez M, Arias S, Santamaría M, López-Dequidt I, López-Loureiro I, Rodríguez-Pérez M, Hervella P, Sobrino T, Campos F, Castillo J, Iglesias-Rey R. Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis. Front Neurol 2019; 10:388. [PMID: 31057479 PMCID: PMC6478658 DOI: 10.3389/fneur.2019.00388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
Identifying the complexities of the effect of sex on stroke risk, etiology, and lesion progression may lead to advances in the treatment and care of ischemic stroke (IS) and non-traumatic intracerebral hemorrhage patients (ICH). We studied the sex-related discrepancies on the clinical course of patients with IS and ICH, and we also evaluated possible molecular mechanisms involved. The study's main variable was the patient's functional outcome at 3-months. Logistic regression models were used in order to study the influence of sex on different inflammatory, endothelial and atrial dysfunction markers. We recruited 5,021 patients; 4,060 IS (54.8% male, 45.2% female) and 961 ICH (57.1% male, 42.9% female). Women were on average 5.7 years older than men (6.4 years in IS, 5.1 years in ICH), and more likely to have previous poor functional status, to suffer atrial fibrillation and to be on anticoagulants. IS patients showed sex-related differences at 3-months regarding poorer outcome (55.6% women, 43.6% men, p < 0.0001), but this relationship was not found in ICH (56.8% vs. 61.9%, p = 0.127). In IS, women had higher levels of NT-proBNP and 3-months worse outcome in both cardioembolic and non-cardioembolic stroke patients. Stroke patients showed sex-related differences in pre-hospital data, clinical variables and molecular markers, but only IS patients presented independent sex-related differences in 3-months poor outcome and mortality. There was a relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, resulting in a possible indicator of increased dysfunction.
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Affiliation(s)
- Emilio Rodríguez-Castro
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Susana Arias
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - María Santamaría
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Ignacio López-Loureiro
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Manuel Rodríguez-Pérez
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Hervella
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Ramón Iglesias-Rey
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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22
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Zrelak PA. Sex-Based Differences in Symptom Perception and Care-Seeking Behavior in Acute Stroke. Perm J 2019; 22:18-042. [PMID: 30285913 DOI: 10.7812/tpp/18-042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Lack of early stroke recognition and delays in seeking emergency care by persons experiencing a stroke severely limit acute treatment options. Sparse and sometimes conflicting evidence suggests sex differences in care-seeking behaviors in stroke, stroke knowledge, perceptions of stroke symptoms, and the importance of physical location at the time of stroke and of having a witnessed stroke. OBJECTIVE To explore specific sex-based differences in stroke presentation and associated care-seeking behaviors. DESIGN Descriptive study based on a convenience sample of 60 patients with stroke admitted to an academic medical center in Northern California. MAIN OUTCOME MEASURES Impact of the patient's sex on 1) time to presentation (early [≤ 4.5 hours] vs late [> 4.5 hours]); 2) perception of symptoms and clinical signs; 3) stroke knowledge and decision making; 4) physical location at the time of stroke; and 5) bystander presence and assistance with decision making. RESULTS There was a discrepancy between how patients perceive symptoms and their medical findings on physical examination. Although most patients had at least one sign or symptom associated with nationally used stroke recognition acronyms, both sexes delayed care because they did not perceive their symptoms as urgent. Early-presenting men were more likely to have a higher stroke severity score at admission, receive alteplase, arrive by Emergency Medical Services, and have a witnessed stroke. Both early- and late-presenting women reported more nonfocal symptoms than did men. CONCLUSION This study suggests that there are sex-based differences in symptom perception and care-seeking behavior in acute ischemic stroke.
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Affiliation(s)
- Patricia A Zrelak
- Clinical Practice Consultant at the Kaiser Foundation Hospital in Sacramento, CA
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