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Observational Study
. 2023 Oct;43(10):1803-1809.
doi: 10.1177/0271678X231189908. Epub 2023 Jul 17.

Exploring sex differences for acute ischemic stroke clinical, imaging and thrombus characteristics in the INTERRSeCT study

Alexander D Rebchuk  1 , Michael D Hill  2   3 , Mayank Goyal  2   3   4 , Andrew Demchuk  2   3 , Shelagh B Coutts  2   3 , Negar Asdaghi  5 , Dar Dowlatshahi  6   7 , Jessalyn K Holodinsky  2 , Enrico Fainardi  8 , Jai Shankar  9 , Mohamed Najm  2 , Marta Rubiera  10 , Alexander V Khaw  11 , Wu Qiu  4 , Bijoy K Menon  2   3   4 , Thalia S Field  12   13   14
Affiliations
Observational Study

Exploring sex differences for acute ischemic stroke clinical, imaging and thrombus characteristics in the INTERRSeCT study

Alexander D Rebchuk et al. J Cereb Blood Flow Metab. 2023 Oct.

Abstract

Women, especially following menopause, are known to have worse outcomes following acute ischemic stroke. One primary postulated biological mechanism for worse outcomes in older women is a reduction in the vasculoprotective effects of estrogen. Using the INTERRseCT cohort, a multicentre international observational cohort studying recanalization in acute ischemic stroke, we explored the effects of sex, and modifying effects of age, on neuroradiological predictors of recanalization including robustness of leptomeningeal collaterals, thrombus burden and thrombus permeability. Ordinal regression analyses were used to examine the relationship between sex and each of the neuroradiological markers. Further, we explored both multiplicative and additive interactions between age and sex. All patients (n = 575) from INTERRseCT were included. Mean age was 70.2 years (SD: 13.1) and 48.5% were women. In the unadjusted model, female sex was associated with better collaterals (OR 1.37, 95% CIs: 1.01-1.85), however this relationship was not significant after adjusting for age and relevant comorbidities. There were no significant interactions between age and sex. In a large prospective international cohort, we found no association between sex and radiological predictors of recanalization including leptomeningeal collaterals, thrombus permeability and thrombus burden.

Keywords: Stroke; collaterals; menopause; recanalization; thrombus.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Field receives in-kind study medication from Bayer Canada and has received honoraria for advisory board work for HLS Therapeutics and Roche Canada. She is supported by a Sauder/Heart and Stroke Professorship from the University of British Columbia, the Vancouver Coastal Health Research Institute, the Michael Smith Institute for Health Research, and the Heart and Stroke Foundation of Canada. Dr. Menon reported holding stock and a patent for systems of triage in acute stroke in Circle NVI. Dr. Dowlatshahi reported receiving a grant from Heart & Stroke Foundation of Canada and personal fees from Apopharma, BMS, and Bayer. Dr Goyal reported receiving research grants to the University of Calgary by Stryker and Cerenovus and receiving consulting fees from Stryker, Mentice, Medtronic and Microvention. Dr. Demchuk reported receiving honoraria from Medtronic and holding stock and a patent in Circle NVI, a startup stroke imaging software company. Dr Hill reports grants from Covidien (Medtronic LLC), grants from Alberta Innovates, grants from Heart & Stroke Foundation of Canada, grants from Canadian Institutes of Health Research (Canadian Stroke Prevention Intervention Network), grants from University of Calgary (Hotchkiss Brain Institute), grants from Boehringer Ingelheim Canada, grants from NoNO, Inc, and grants from Biogen. In addition, Dr Hill has a patent to US Patent office Number: 62/086,077 and is Stock owner in Pure Web Incorporated and CircleNVI. Dr. Hill is a director of the Canadian Federation of Neurological Sciences, a not-for-profit group, is a director of the Canadian Stroke Consortium, a not-for-profit group, is a director of Circle NeuroVascular, and has received public grant support to the University of Calgary from Alberta Innovates Health Solutions, Canadian Institutes of Health Research, Heart & Stroke Foundation of Canada and National Institutes of Neurological Disorders and Stroke. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Distribution of age by sex in the INTERRseCT cohort.
See this image and copyright information in PMC

References

    1. Appelros P, Stegmayr B, Terént A. Sex differences in stroke epidemiology: a systematic review. Stroke 2009; 40: 1082–1090. - PubMed
    1. Phan HT, Blizzard CL, Reeves MJ, et al.. Sex differences in long-term mortality after stroke in the INSTRUCT (INternational STRoke oUtComes sTudy): a meta-analysis of individual participant data. Circ Cardiovasc Qual Outcomes 2016; 47: e003436. - PubMed
    1. Joundi RA, Adekanye J, Leung AA, et al.. Health state utility values in people with stroke: a systematic review and meta-analysis. J Am Heart Assoc 2022; 11: e024296. - PMC - PubMed
    1. Benkhadra K, Mohammed K, Al Nofal A, et al.. Menopausal hormone therapy and mortality: a systematic review and meta-analysis. J Clin Endocrinol Metab 2015; 100: 4021–4028. - PubMed
    1. RoyO’Reilly M, McCullough LD. Sex differences in stroke: the contribution of coagulation. Exp Neurol 2014; 259: 16–27. - PMC - PubMed

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