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Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.

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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Sex differences in revascularization interventions after acute ischemic stroke.

Amytis Towfighi1, Daniela Markovic, Bruce Ovbiagele

  • 1Department of Neurology at the University of Southern California, Los Angeles, California; Department of Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|May 11, 2013
PubMed
Summary

Women with acute ischemic stroke (AIS) received fewer reperfusion therapies than men. However, the gap in intravenous (IV) tissue plasminogen activator (tPA) use narrowed significantly, suggesting improved equity in stroke treatment over time.

Keywords:
Cardiacproceduresrevascularizationsex differencesstroke

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Area of Science:

  • Neurology
  • Cardiology
  • Public Health

Background:

  • Studies indicate women receive less intravenous (IV) tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) compared to men.
  • Existing research lacks comprehensive data on sex disparities in broader AIS management and national trends.

Purpose of the Study:

  • To investigate sex-based differences in the utilization of cerebrovascular and cardiac reperfusion therapies for acute ischemic stroke (AIS) in the United States.
  • To analyze national practice patterns and temporal changes in these disparities from 1997 to 2006.

Main Methods:

  • Analysis of Nationwide Inpatient Sample data (1997-2006) for adults with primary AIS diagnosis (n=4,453,207).
  • Examination of sex-specific rates for reperfusion procedures (IV tPA, intra-arterial therapy, angioplasty, stenting, carotid endarterectomy, cardiac catheterization, bypass grafts) in 1056 hospitals.
  • Adjustment for sociodemographic, clinical, and hospital factors to assess disparities.

Main Results:

  • Men were more likely than women to receive IV tPA, catheter angiography, intracranial/extracranial angioplasty/stent, carotid endarterectomy (CEA), and cardiac reperfusion therapy.
  • Multivariable adjustment minimally reduced the observed sex disparities.
  • While use of most procedures increased in both sexes from 1997-2006, IV tPA use rose faster in women, eliminating the sex difference by 2006.

Conclusions:

  • Women hospitalized for AIS in the U.S. historically received less cerebrovascular and cardiac reperfusion therapy than men.
  • The disparity in IV tPA treatment for AIS between sexes appears to have been resolved by 2006.
  • Findings highlight evolving trends in stroke care equity, with specific therapies showing improved parity over time.