Abstract
BackgroundWomen have been reported to show more frequent recanalization and better recovery after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment for acute stroke compared with men. To investigate this we studied a series of stroke patients receiving IV rt-PA and undergoing acute transcranial doppler (TCD) examination.MethodsAcute stroke patients received IV rt-PA and had acute TCD examination within 4 hours of symptom onset at 4 major stroke centers. TCD findings were interpreted using the Thrombolysis in Brain Ischemia (TIBI) flow grading system. The recanalization rates, and poor 3-month outcomes (modified Rankin scale >2) of men and women were compared using the chi-square test. Multiple regression analysis was used to assess sex as a predictor of recanalization and poor 3-month outcome after controlling for age, baseline NIH Stroke Scale (NIHSS), time to treatment, hypertension, and blood glucose.Results369 patients had TCD examinations before or during IV rt-PA treatment. The 199 (53.9%) men and 170 (46.1%) women had mean ages of 67 ± 13 and 70 ± 14 years, respectively. The sexes did not differ significantly in baseline stroke severity, time to TCD examination, or time to thrombolysis. Of the men, 68 (34.2%) had complete recanalization, 58 (29.1%) had partial recanalization, and 73 (36.6%) had no recanalization. Of the women, 53 (31.2%) had complete recanalization, 46 (27%) had partial recanalization, and 71 (41.8%) had no recanalization (p = 0.6). Multiple regression analyses showed no difference between the sexes in recanalization rate, time to recanalization, or clinical outcome at 3 months.ConclusionsIn our study; sex is not a significant predictor of recanalization rate, time to recanalization or 3-month outcome in stroke patients following IV rt-PA.Trial registrationData from CLOTBUST trial Clinicaltrails.gov Identifier: NCT01240356.
Highlights
Women have been reported to show more frequent recanalization and better recovery after intravenous (IV) recombinant tissue plasminogen activator treatment for acute stroke compared with men
The aim of our study is to evaluate whether sex differences play a role in predicting immediate and 3-month outcomes in IV recombinant tissue plasminogen activator (rt-PA) treated patients
Patients and clinical assessments The present analysis included all rt-PA treated patients with symptoms of acute cerebral ischemia caused by an intracranial artery [middle cerebral artery (MCA), terminal internal cerebral artery (TICA), anterior cerebral artery (ACA), basilar artery and vertebral artery] with occlusion on pre-treatment transcranial doppler (TCD) according to the criteria validated by our group [18]
Summary
Women have been reported to show more frequent recanalization and better recovery after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment for acute stroke compared with men. To investigate this we studied a series of stroke patients receiving IV rt-PA and undergoing acute transcranial doppler (TCD) examination. Large epidemiological studies found that women with stroke have worse functional outcomes compared with men [9,10,11,12] These findings could be explained by sex-based differences in coagulation and fibrinolysis parameters [13].
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