Sex-specific differences in presentations and determinants of outcomes after endovascular thrombectomy for large vessel occlusion stroke

If you don't use this information to update the appropriate stroke protocols you have just wasted your research. Writing in journals does nothing to get better treatments into hospitals. 

Sex-specific differences in presentations and determinants of outcomes after endovascular thrombectomy for large vessel occlusion stroke

• Robert W. Regenhardt,
• Ashby C. Turner,
• Joshua A. Hirsch,
• Michael J. Young,
• Naif M. Alotaibi,
• Christopher J. Stapleton,
• Aman B. Patel,
• Thabele M. Leslie-Mazwi,
• Natalia S. Rost &
• Mark R. Etherton 

Journal of Neurology (2021)Cite this article

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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(Wrong outcome measurement) and functional outcomes compared to men. Sex-specific determinants of reperfusion and functional outcome were identified that require further study.

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Data availability

The data that support the findings of this study will be made available from the corresponding author upon reasonable request and pending approval of local institutional review board.

 

Assessment of sex differences in recovery of motor and sensory impairments poststroke

Darn, this is not about how much sex men vs. women need post stroke to 100% recover. So go ask your doctor for EXACTLY HOW MUCH SEX YOU SHOULD BE HAVING TO RECOVER.  I'M DEADLY SERIOUS. Why the fuck doesn't your doctor know that answer?

 

 Assessment of sex differences in recovery of motor and sensory impairments poststroke

 Neurorehabilitation and Neural Repair (NNR) , Volume 34(8) , Pgs. 746-757.

NARIC Accession Number: J84643.  What's this?
ISSN: 1545-9683.
Author(s): Hawe, Rachel L. ; Cluff, Tyler ; Dowlatshahi, Dar ; Hill, Michael D. ; Dukelow, Sean P..
Publication Year: 2020.
Number of Pages: 12.
Abstract: Study used robotic assessments of motor and sensory impairments to determine if there are sex differences at the impairment level in stroke recovery over the first 6 months post stroke. Robotic and clinical assessments of motor and sensory impairments were performed at 1, 6, 12, and 26 weeks poststroke in 108 males and 52 females. Linear mixed models were used to examine the effect of sex on poststroke recovery, controlling for age and lesion volume. In general, the study found no significant sex differences across a range of assessments. The exception to this was a sex-by-age interaction for the Purdue Pegboard Assessment, where results showed that females had better performance than males at younger ages (under 62 years), but males had better performance at older ages. While recruitment biases need to be acknowledged when generalizing these findings to stroke recovery at-large, the results suggest that sex differences do not exist at the impairment level poststroke.
Descriptor Terms: FEMALES, FUNCTIONAL EVALUATION, FUNCTIONAL LIMITATIONS, IMAGING, MALES, MOTOR SKILLS, OUTCOMES, REHABILITATION, ROBOTICS, SENSORY IMPAIRMENTS, STROKE, TESTS.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://journals.sagepub.com/doi/full/10.1177/1545968320935811.

Citation: Hawe, Rachel L. , Cluff, Tyler , Dowlatshahi, Dar , Hill, Michael D. , Dukelow, Sean P.. (2020). Assessment of sex differences in recovery of motor and sensory impairments poststroke.  Neurorehabilitation and Neural Repair (NNR) , 34(8), Pgs. 746-757. Retrieved 10/14/2020, from REHABDATA database.

Chapter 19 - Sex differences in stroke

Darn, this is not about how much sex men vs. women need post stroke to 100% recover. So go ask your doctor for EXACTLY HOW MUCH SEX YOU SHOULD BE HAVING TO RECOVER.  I'M DEADLY SERIOUS. Why the fuck doesn't your doctor know that answer?

Chapter 19 - Sex differences in stroke

Author links open overlay panelPeterAppelros¹

SignildÅsberg²

https://doi.org/10.1016/B978-0-444-64123-6.00021-7Get rights and content

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.

 

Sex Differences in Stroke Thrombolysis — Meta-analysis finds treatment less common in women; reasons unclear

The takeaway from this should be to get objective stroke diagnosis from having EXACT STROKE DIAGNOSIS PROTOCOLS. That would lead directly to an intervention protocol. All this would take subjective analysis by neurologists out of the picture.  With that we could also solve the young adult stroke misdiagnosis. 

But nothing will occur, we have NO STROKE LEADERSHIP to contact and get stuff done. 

Sex Differences in Stroke Thrombolysis - Meta-analysis finds treatment less common in women; reasons unclear

by Judy George, Senior Staff Writer, MedPage Today June 10, 2020

Women with ischemic stroke were less likely than men to be treated with intravenous tissue plasminogen activator (tPA), a meta-analysis suggested.
In 17 studies published from 2008 to 2018, women had 13% lower odds of receiving thrombolytic treatment than men (summary unadjusted random effects OR 0.87, 95% CI 0.82-0.93), reported Mathew Reeves, PhD, of Michigan State University in East Lansing, and colleagues in Neurology.
An earlier summary by Reeves and colleagues of studies published from 2000 to 2008 showed that women were 30% less likely than men to receive tPA. "In this latest review, we showed that the treatment gap had narrowed to 13%, but was still present," Reeves said.
"Any treatment gap found for women is to their detriment," Reeves told MedPage Today.
"Over the life course, more women than men suffer a stroke," he continued. "Women are older when they have their stroke and have greater disability, both at onset and afterwards. Thrombolysis can help reduce these higher rates of disability in women, if they receive it."
In actual numbers, the absolute difference in thrombolysis treatment rates in the studies between men and women was small.
"Most of the studies showed differences of 0.5% to 1.0%," Reeves said. The largest difference was 8.4% in one study, but even small differences can translate into many untreated women considering how common stroke is, he added.
The summary finding "could reflect some form of reporting bias because this is a meta-analysis and not primary data," said Michael Hill, MD, of the University of Calgary in Canada, who wasn't involved with the research. "Other factors may be influencing this observation, ranging from methodological to confounding by other conditions."
In clinical trials and registries he's aware of, thrombolytic treatment decisions do not seem to favor men, Hill noted. But "there are some data to say that symptom presentations may vary between men and women, and this might introduce bias in treatment choice," he told MedPage Today.
"Patient preference on treatment may be an important consideration for milder strokes, but I would estimate that major strokes are treated regardless of sex," Hill added. "Very old patients, who are more likely to be women, may be less likely to be treated due to comorbid disability."
In the analysis, Reeves and his team identified 17 studies published from 2008 to 2018 that reported sex-specific tPA treatment and included representative populations of ischemic stroke patients from hospital, registry, or administrative data. They generated random effects odds ratios to quantify sex differences.
Overall, the researchers found substantial between-study variability. Only seven studies provided data about the subgroup of patients eligible for tPA treatment because they arrived at the hospital within the right time window and had no other contraindications. Thrombolytic treatment was not significantly lower for women in that subgroup (summary adjusted OR 0.95, 95% CI 0.88-1.02).
Delays make patients ineligible for treatment, Reeves pointed out. Women are more likely to live alone and may arrive later at the hospital, or may not be aware of when symptoms started compared with people who live with a partner, he added.
When the researchers combined data from this meta-analysis with their 2000-2008 meta-analysis and categorized all research into four time periods, they found that more recent studies tended to show smaller sex differences.
The research had several limitations, they noted. Heterogeneity complicated interpretations of pooled effect estimates. Only five studies were conducted with the specific goal of examining sex differences in tPA use.
Treatment disparity appeared to be partially explained by sex differences in eligibility, and further work is needed to understand its origins, they added. "Disparities in care, whether they are based on gender, age, race, socioeconomic, or educational status, need to be identified, studied, and hopefully eliminated," Reeves said.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

Reeves and co-authors disclosed no relevant relationships with industry.

Primary Source

Neurology

Source Reference: Strong B, et al "Sex differences in IV thrombolysis treatment for acute ischemic stroke: A systematic review and meta-analysis" Neurology 2020; DOI: 10.1212/WNL.0000000000009733.