By: Dr Cheryl Carcel, MD and Dr Amy Yu, MD

The session on Sex Differences in Stroke was one of the first communications on Day 1 of the European Stroke Organisation Conference in Milan and it did not disappoint!

A pooled analysis of five large randomized clinical trials (n= 19,652) showed that women had better survival after ischemic stroke but experienced more disability even after adjusting for important confounders. Dr Carcel suggests that variations found in management while in hospital and in preventative medications may partially explain these results.

On the topic of TIA and minor stroke, a Canadian study showed that women and men were equally likely to present with non-focal symptoms, but women were still more likely to be diagnosed with a stroke mimic. The risk of recurrent stroke within 90 days, however, were similar in men and women. Dr Yu’s findings raise questions about missed opportunities in preventing vascular events in women.

There were important mechanistic sex differences explored in this session too. Dr van der Meij used the MR CLEAN registry to examine whether poorer outcomes from endovascular treatment in women could be explained by clot extension, intracranial atherosclerosis, collateral status, or early ischemic damage. She found that women had better collateral status and had less intracranial atherosclerosis compared to men. Dr van Dam-Nolen used the PARISK study to analyse sex differences in plaque compositions in patients with symptomatic carotid artery stenosis. She found that women had less vulnerable plaque compositions compared to men in those with mild to moderate carotid stenosis.

Overall, this was a very successful #ESOC2019 session with good engagement and thought-provoking questions from the crowd.

https://jamanetwork.com/journals/jamaneurology/newonline/2019/5