Gender Differences in Outcomes after Ischemic Stroke: Role of Ischemic Lesion Volume and Intracranial Large-Artery Occlusion

Background: the reasons for gender disparities in stroke outcome remain unclear, and little is known about the value of acute neuroimaging characteristics in elucidating differential stroke outcomes between the sexes. Methods: We prospectively evaluated consecutive patients with acute ischemic stroke. CT angiography (CTA) was performed in all patients within 24 h of symptom onset. CTA source images were used to evaluate lesion volume. the primary outcome measure was a modified Rankin scale (mRS) score >= 3 at 6 months. Results: We evaluated 676 consecutive patients (322 women). Women were older than men (p 0 (p < 0.01), and had higher admission National Institutes of Health Stroke scale scores (p = 0.01). More women had intracranial artery occlusions than men (46 vs. 33.1%, p = 0.01), but there was no significant difference between ischemic lesion volumes (p = 0.21). Using multiple regression, female gender remained an independent predictor of poor mRS scores at 6 months (odds ratio 1.57; 95% confidence interval 1.02-2.36) after adjustment for clinical and imaging covariates. Conclusion: Compared with men, women are less likely to achieve independence after acute ischemic stroke. the disparity in stroke outcome is not explained by differences in ischemic lesion volume or the presence of intracranial artery occlusions. Copyright (C) 2010 S. Karger AG, BaselAgency for Healthcare Research and QualityNational Institutes of HealthDeane Institute for Integrative Research in Stroke and Atrial FibrillationLakeside FoundationMassachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USAMassachusetts Gen Hosp, Dept Radiol, Boston, MA 02114 USAHarvard Univ, Sch Med, Boston, MA USAUniv Calif San Francisco, Dept Neurol, San Francisco, CA 94143 USANatl Inst Neurol Disorders & Stroke, Bethesda, MD USAUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, BrazilAgency for Healthcare Research and Quality: AHRQ R01 HS11392National Institutes of Health: P50NS051343Web of Scienc