Abstract
Introduction: We hypothesized sex-differences in the prevalence of intracranial atherosclerosis (ICAS) among hypertensive patients with ischemic stroke due to ICAS. Methods: Subjects with ischemic stroke secondary to ICAS underwent MR vessel wall imaging (VWI) within 8 weeks of symptom onset. Demographic data, cardiovascular risk factors, and medication history were recorded. A neuroradiologist blinded to clinical history scored proximal (A1/M1/P1) and distal (A2/M2-3/P2) plaques involving the anterior/middle/posterior cerebral arteries. The most stenotic vessel lesion with wall thickening/enhancement and supplying the ischemic territory was defined as a culprit plaque. Continuous variables are summarized by medians and interquartile ranges. Chi square and Mann Whitney U-tests compared categorical and continuous variables, respectively. Results: Sixty-one subjects (male, N=42) with a diagnosis of hypertension and ischemic stroke due to ICAS were included. There were no significant sex-differences in demographic or cardiovascular risk factors except for smoking history (p=0.002). Hypertensive males with ischemic stroke due to ICAS had a significantly higher number of proximal plaques than females [males=8 (4, 10) vs females=5 (3, 7); p=0.03; Figure] but not distal plaques [males=3 (1, 5) vs females=2 (0, 5); p=0.33]. Among subjects on an anti-hypertensive prior to admission (N=35), males with ischemic stroke had a significantly higher proximal plaque burden than females [males=8 (4, 10) vs females=4 (3, 6); p=0.05]. The culprit plaque was proximal in 95% and 92% of cases in males and females treated for hypertension and with ischemic stroke, respectively. Conclusions: Attention to differential management of hypertension for males versus females may be warranted to reduce ischemic stroke risk given significantly higher proximal ICAS burden in hypertensive males than females despite medical treatment.
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