Gender differences in acute ischemic stroke: etiology, stroke patterns and response to thrombolysis

Stroke. 2009 Jul;40(7):2428-32. doi: 10.1161/STROKEAHA.109.548750. Epub 2009 May 21.

Abstract

Background and purpose: Differences between women and men in relation to stroke are increasingly being recognized.

Methods: From July 2004 until June 2007, 237 acute ischemic stroke (AIS) patients were treated with recombinant tissue plasminogen activator (rtPA) within 3 hours after onset of symptoms in our stroke unit. Baseline characteristics, etiology, CT/MRI stroke patterns, clinical outcome, and complications of women were compared to those of men.

Results: Of 237 AIS patients (mean age 70.7 years), 111 (46.8%) were women and 126 (53.2%) were men. Women were older (P=0.001), but history of hyperlipidemia (P=0.03), smoking (P=0.03), and coronary heart disease (P<0.001) was less frequent than in men. Internal carotid artery disease occurred more often in men (P=0.02), whereas atrial fibrillation was observed more often in women (P=0.002). In men borderzone/small embolic and lacunar stroke was found more frequently (39.7 versus 27.2%), whereas women showed a higher percentage of large territorial stroke (72.8 versus 60.3%, P=0.09). Baseline National Institute of Health Stroke Scale scores (12.5 versus 11.3), NIHSS score at discharge (11.0 versus 9.5), 3-month-outcome modified Rankin Scale score, thrombolysis-related (17.1% versus 13.5%) or independent complications (32.4% versus 30.2%), and mortality after 3 months (13.5% versus 9.5%) were similar.

Conclusions: Differences of stroke lesion patterns in genders are paralleled by differences in etiology and risk factor profiles (women, cardioembolism; men, large and small vessel disease). Baseline characteristics, rates of rtPA-related and independent complications, as well as clinical outcomes were not different between women and men with AIS.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / complications
  • Carotid Artery Diseases / complications
  • Coronary Disease / complications
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Hyperlipidemias / complications
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Recombinant Proteins / therapeutic use*
  • Risk Factors
  • Sex Characteristics*
  • Smoking / adverse effects
  • Stroke / drug therapy*
  • Stroke / etiology*
  • Stroke / pathology
  • Thrombolytic Therapy* / methods
  • Tissue Plasminogen Activator / therapeutic use*

Substances

  • Fibrinolytic Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator