Gender Differences in Outcomes Among Patients With Symptomatic Intracranial Arterial Stenosis

Williams, Janice E.; Chimowitz, Marc I.; Cotsonis, George; Lynn, Michael; Waddy, Salina P.

doi:10.1161/strokeaha.107.482240

Cited by 51 publications

(37 citation statements)

References 31 publications

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“…23 There was a significant increase in symptomatic middle cerebral artery involvement in female patients as compared to male patients in the WASID study; this could explain the greater benefit of thrombolysis in female patients, and a worse prognosis if not treated. 24 It is also possible that the impact is a social one. Whereas women may care for men, who tend to have Abbreviations: BP ϭ blood pressure; CHF ϭ congestive heart failure; CNS ϭ Canadian Neurological Scale; GCS ϭ Glasgow Coma Scale; LACS ϭ lacunar stroke; NIHSS ϭ NIH Stroke Scale; OCSP ϭ Oxfordshire Community Stroke Project; PACS ϭ partial anterior circulation stroke; POCS ϭ posterior circulation stroke; TACS ϭ total anterior circulation stroke; tPA ϭ tissue plasminogen activator.…”

Section: Resultsmentioning

confidence: 99%

Differences in stroke outcome based on sex

Shobha¹,

Sylaja²,

Kapral³

et al. 2010

Neurology

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Objective: Stroke thrombolysis may have a differential effect by sex. We sought to examine the relationship between sex and outcome after thrombolysis. Variables including demographics, history, clinical data, process measures, and outcome were analyzed. The primary outcomes were the Stroke Impact Scale-16 score (SIS-16) and mortality at 6 months. We compared the outcomes of the thrombolyzed and nonthrombolyzed cohorts and examined the data for a tissue plasminogen activator (tPA)-by-sex interaction on the 2 primary outcomes. Methods: Results:The overall proportion of patients who achieved an excellent outcome (SIS-16 Ͼ75) was not different by gender. However, the proportion of patients achieving an excellent outcome in the non-tPA cohort was much greater in males, with an absolute risk difference of 11.8%. A multiplicative treatment by sex interaction was evident (p ϭ 0.054). This interaction was not present for stroke case fatality. Conclusions:Women fared poorly compared to men in the placebo groups, but this negative prognostic sex effect was neutralized by thrombolysis. Neurology

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Section: Resultsmentioning

confidence: 99%

Differences in stroke outcome based on sex

Shobha¹,

Sylaja²,

Kapral³

et al. 2010

Neurology

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“…Patients with ICASD represent a more challenging group than those with MMD, as they are typically older, have higher cardiac risk, and have been shown to be more resistant to other forms of treatment, such as direct bypass and angioplasty and stenting, with high recurrent stroke rates reported in the literature despite intensive medical management. [1][2][3]11,13,19,23 Observations in clinical trials have confirmed an important role for collateral circulation in averting stroke in ICASD, providing pathophysiological support for the hypothesis that collateral enhancement by EDAS could improve outcome. Evaluation of the WASID (WarfarinAspirin for Symptomatic Intracranial Disease) population demonstrated that when the degree of arterial luminal stenosis was severe (≥ 70%), the presence of good collaterals had a dramatic role in averting stroke.…”

Section: Discussionmentioning

confidence: 92%

“…23,24 Interventions such as angioplasty and stenting or bypass surgery have failed to improve outcomes in ICASD 1,2,19 and have not been tested in pivotal clinical trials for MMD. Although the short-term (30-day) stroke and death rates with angioplasty alone have been shown to be low (3.3%) in one study subgroup, the longer-term (2-year) outcomes of these techniques have been disappointing (18% 2-year stroke rate in the SAMMPRIS [Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis] trial) and no better than medical management alone.…”

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confidence: 99%

Encephaloduroarteriosynangiosis for adult intracranial arterial steno-occlusive disease: long-term single-center experience with 107 operations

Gonzalez

Dusick²,

Connolly³

et al. 2015

JNS

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E ncEphaloduroartEriosynangiosis (EDAS) is a form of indirect revascularization that has been used for the treatment of pediatric moyamoya disease (MMD) since the 1970s. 20 The application of EDAS for adults with MMD has shown promising results in the early postoperative period 6 and its use has been extended to the treatment of select patients with intracranial atherosclerotic steno-occlusive disease (ICASD).7 ICASD is the most common cause of stroke worldwide. 4,10,25 It accounts for at least 10% of all strokes in the United States 21 and as much as 33%-67% of stroke in countries with predominantly Asian, Hispanic, and black populations.10 ICASD carries a worse prognosis than other stroke etiologies, with an annual rate of recurrent stroke and death of 15% despite obJect Encephaloduroarteriosynangiosis (EDAS) is a form of revascularization that has shown promising early results in the treatment of adult patients with moyamoya disease (MMD) and more recently in patients with intracranial atherosclerotic steno-occlusive disease (ICASD). Herein the authors present the long-term results of a single-center experience with EDAS for adult MMD and ICASD. methods Patients with ischemic symptoms despite intensive medical therapy were considered for EDAS. All patients undergoing EDAS were included. Clinical data, including recurrence of transient ischemic attack (TIA) and/or stroke, functional status, and death, were collected from a retrospective data set and a prospective cohort. Perren revascularization and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grades were recorded from angiograms. results A total of 107 EDAS procedures were performed in 82 adults (36 with ICASD and 46 with MMD). During a median follow-up of 22 months, 2 (2.4%) patients had strokes; both patients were in the ICASD group. TIA-free survival and stroke-free survival analyses were performed using the product limit estimator (Kaplan-Meier) method. The probability of stroke-free survival at 2 years in the ICASD group was 94.3% (95% CI 80%-98.6%). No patient in the MMD group suffered a stroke. The probability of TIA-free survival at 2 years was 89.4% (95% CI 74.7%-96%) in ICASD and 99.7% (95% CI 87.5%-99.9%) in MMD. There were no hemorrhages or stroke-related deaths. Angiograms in 85.7% of ICASD and 92% of MMD patients demonstrated Perren Grade 3 and improvement in ASITN/SIR grade in all cases. coNclusioNs EDAS is well tolerated in adults with MMD and ICASD and improves collateral circulation to territories at risk. The rates of stroke after EDAS are lower than those reported with other treatments, including intensive medical therapy in patients with ICASD.

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“…However, to date, sex difference of outcomes among patients with ICAS in China as well as in the world has not been reported. Until 2007, the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study [15] provided very important evidence that women with symptomatic intracranial arterial stenosis have considerable increased risk for stroke and vascular death than men. However, the WASID study was a randomized clinical trial that had firm inclusion and exclusion criteria.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences Do Not Exist in Outcomes among Stroke Patients with Intracranial Atherosclerosis in China: Subgroup Analysis from the Chinese Intracranial Atherosclerosis Study

Wei²,

Yu³

et al. 2017

Neuroepidemiology

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Background: To date, sex difference in outcomes among patients with intracranial atherosclerosis (ICAS) has rarely been discussed in China as well as in the world. This study aimed to estimate the sex difference in outcomes among patients with ICAS in Chinese cerebral ischemia patients. Methods: We analyzed 1,335 men and women with ICAS who were enrolled in the Chinese Intracranial Atherosclerosis study. They were followed-up for ischemic stroke recurrence, any cause of death, cerebral vascular events (including transient ischemic attack, ischemic and hemorrhagic stroke), combined end points (including cerebral vascular events, angina or myocardial infarction, pulmonary embolism, peripheral vascular events), and unfavorable outcome (modified Rankin scale score of 3-6) at 1 year. Results: During the follow-up period, 59 (13.44%) combined end points were documented in women and 107 (11.94%) in men. Of the combined end points, 47 were recurrent ischemic stroke events (14 in women and 33 in men), and 51 other causes of deaths (24 in women and 27 in men). There were 349 unfavorable end points (117 in women and 232 in men). The cumulative probability of death was higher in women, but after adjusting for age, diabetes mellitus, hypertension, family history of stroke, current smoker, heavy drinking, hyperhomocysteinemia, and heart disease, there was no significant difference. There was also a lack of difference in 1-year ischemic stroke recurrence, cerebral vascular events, combined end points, and unfavorable outcome between women and men at 1 year. Conclusions: These results suggest no sex difference in outcome among patients with ICAS in Chinese cerebral ischemia patients.

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Gender Differences in Outcomes Among Patients With Symptomatic Intracranial Arterial Stenosis

Cited by 51 publications

References 31 publications

Differences in stroke outcome based on sex

Differences in stroke outcome based on sex

Encephaloduroarteriosynangiosis for adult intracranial arterial steno-occlusive disease: long-term single-center experience with 107 operations

Sex Differences Do Not Exist in Outcomes among Stroke Patients with Intracranial Atherosclerosis in China: Subgroup Analysis from the Chinese Intracranial Atherosclerosis Study

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