Published online before print June 9, 2005, doi: 10.1161/01.STR.0000170647.42126.a8
(Stroke. 2005;36:1447.)
© 2005 American Heart Association, Inc.
Original Contributions |
Arterial Occlusive Lesions Recanalize More Frequently in Women Than in Men After Intravenous Tissue Plasminogen Activator Administration for Acute Stroke
From the Division of Cerebrovascular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Correspondence to Magdy Selim, MD, PhD, Department of Neurology, Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Palmer 127, Boston, MA 02215. E-mail mselim{at}bidmc.harvard.edu
Background and Purpose— Previous reports suggest that women achieve better outcome than men after intravenous thrombolysis for ischemic stroke. Coagulation and fibrinolysis differ between sexes. These findings prompted us to investigate possible gender differences in arterial recanalization after intravenous tissue plasminogen activator (IV tPA).
Methods— We identified 100 consecutive patients who presented with acute ischemic stroke and received IV tPA within 6 hours of onset. Only patients with large artery anterior circulation strokes, as determined by MRI/MRA or CT/CTA before treatment, who had follow-up vascular study within 72 hour after treatment were included. We compared demographics, clinical features, admission medications, symptom-to-needle and treatment-to-repeat vascular imaging times, baseline National Institutes of Health Stroke Severity score, radiological and laboratory data, stroke mechanism, and outcome between the sexes.
Results— 39 patients met all inclusion/exclusion criteria (22 men and 17 women). The recanalization rate was significantly higher in women (94% versus 59%; P=0.02). This difference remained statistically significant after excluding patients whose strokes were attributed to internal carotid artery occlusive lesions, and when the analysis was limited to those treated within 3 hours of stroke onset. All other confounding variables did not differ significantly between the sexes.
Conclusions— In our cohort, vascular occlusive lesions were more likely to recanalize in women than men in response to IV tPA. These preliminary findings need to be validated in larger prospective studies.
Key Words: gender • outcome • stroke • thrombolysis
This article has been cited by other articles:
 |
|
 |
|
  K.A. Dani and K.W. Muir Do Iodinated Contrast Agents Impair Fibrinolysis in Acute Stroke? A Systematic Review AJNR Am. J. Neuroradiol., January 1, 2010; 31(1): 170 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Khatri, T. Abruzzo, S. D. Yeatts, C. Nichols, J. P. Broderick, T. A. Tomsick, and For the IMS I and II Investigators Good clinical outcome after ischemic stroke with successful revascularization is time-dependent Neurology, September 29, 2009; 73(13): 1066 - 1072. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Forster, A. Gass, R. Kern, M. E. Wolf, C. Ottomeyer, K. Zohsel, M. Hennerici, and K. Szabo Gender Differences in Acute Ischemic Stroke: Etiology, Stroke Patterns and Response to Thrombolysis Stroke, July 1, 2009; 40(7): 2428 - 2432. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Meseguer, M. Mazighi, J. Labreuche, C. Arnaiz, L. Cabrejo, T. Slaoui, C. Guidoux, J.-M. Olivot, H. Abboud, B. Lapergue, et al. Outcomes of Intravenous Recombinant Tissue Plasminogen Activator Therapy According to Gender: A Clinical Registry Study and Systematic Review Stroke, June 1, 2009; 40(6): 2104 - 2110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Petrea, A. S. Beiser, S. Seshadri, M. Kelly-Hayes, C. S. Kase, and P. A. Wolf Gender Differences in Stroke Incidence and Poststroke Disability in the Framingham Heart Study Stroke, April 1, 2009; 40(4): 1032 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Arenillas, P. Sandoval, N. Perez de la Ossa, M. Millan, C. Guerrero, D. Escudero, L. Dorado, E. Lopez-Cancio, J. Castillo, and A. Davalos The Metabolic Syndrome Is Associated With a Higher Resistance to Intravenous Thrombolysis for Acute Ischemic Stroke in Women Than in Men Stroke, February 1, 2009; 40(2): 344 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Barrett and B. B. Worrall Sex and stroke: Are they really different in midlife? Neurology, November 13, 2007; 69(20): 1894 - 1895. [Full Text] [PDF]
|
|
|
|
|
|
T. Rundek Do Women Have Worse Outcome After Stroke Caused by Intracranial Arterial Stenosis? Stroke, July 1, 2007; 38(7): 2025 - 2027. [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, L. Kappeler, K. Nedeltchev, C. Brekenfeld, U. Fischer, B. Keserue, L. Remonda, G. Schroth, and H. P. Mattle Recanalization and Outcome After Intra-Arterial Thrombolysis in Middle Cerebral Artery and Internal Carotid Artery Occlusion: Does Sex Matter? Stroke, April 1, 2007; 38(4): 1281 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.S.V. Elkind, S. Prabhakaran, J. Pittman, W. Koroshetz, M. Jacoby, K. C. Johnston, and for the GAIN Americas Investigators Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke Neurology, March 13, 2007; 68(11): 842 - 848. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Benchenane, H. Castel, M. Boulouard, R. Bluthe, M. Fernandez-Monreal, B. D. Roussel, J. P. Lopez-Atalaya, S. Butt-Gueulle, V. Agin, E. Maubert, et al. Anti-NR1 N-terminal-domain vaccination unmasks the crucial action of tPA on NMDA-receptor-mediated toxicity and spatial memory J. Cell Sci., February 15, 2007; 120(4): 578 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Zangerle, S. Kiechl, M. Spiegel, M. Furtner, M. Knoflach, P. Werner, A. Mair, G. Wille, C. Schmidauer, K. Gautsch, et al. Recanalization after thrombolysis in stroke patients: Predictors and prognostic implications Neurology, January 2, 2007; 68(1): 39 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Kent, H. P. Selker, R. Ruthazer, E. Bluhmki, and W. Hacke Can Multivariable Risk-Benefit Profiling Be Used to Select Treatment-Favorable Patients for Thrombolysis in Stroke in the 3- to 6-Hour Time Window? Stroke, December 1, 2006; 37(12): 2963 - 2969. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Hill, D. M. Kent, J. Hinchey, H. Rowley, A. M. Buchan, L. R. Wechsler, R. T. Higashida, N. J. Fischbein, W. P. Dillon, M. Gent, et al. Sex-Based Differences in the Effect of Intra-Arterial Treatment of Stroke: Analysis of the PROACT-2 Study Stroke, September 1, 2006; 37(9): 2322 - 2325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Shah, D. S. Liebeskind, J. L. Saver, S. Starkman, F. Vinuela, G. Duckwiler, R. Jahan, D. Kim, N. Sanossian, P. Vespa, et al. Influence of gender on outcomes after intra-arterial thrombolysis for acute ischemic stroke Neurology, June 13, 2006; 66(11): 1745 - 1746. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Kent, M. D. Hill, S. I. Savitz, and M. Selim Gender Differences in tPA-Related Arterial Recanalization * Response: Stroke, December 1, 2005; 36(12): 2529 - 2530. [Full Text] [PDF]
|
|