Abstract WP83: Validation of a Relative Non-Contrast CT Map to Detect Early Ischemic Changes in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Margy E McCullough-Hicks ◽  
Soren Christensen ◽  
Aditya Srivatsan ◽  
Gregory W Albers ◽  
Maarten Lansberg
Keyword(s):  
Acute Stroke ◽  
Brain Regions ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Test Characteristics ◽  
Contrast Ct ◽  
Sensitivity Specificity ◽  
Early Infarction

Background: Discerning signs of early infarct on the non-contrast CT (NCCT) can be difficult. To facilitate interpretation of the NCCT we previously developed a technique to generate symmetry ratio maps of the NCCT (rNCCT maps) on which subtle (≥5%) differences in density between symmetric brain regions are enhanced. We sought to validate the rNCCT map against other measures of early infarction in a large cohort. Methods: rNCCT maps were generated for 146 ischemic stroke patients. We assessed how often a neurologist’s interpretation of the NCCT was changed when provided with the rNCCT map. The neurologist was blinded to CTP and DWI but was given the infarct hemisphere. In addition, using the 24-hour DWI as the gold standard, we assessed the sensitivity, specificity and volumetric accuracy of the rNCCT-defined infarct core and compared this to the test characteristics of CTP-defined infarct core (CBF<38% threshold). Results: Addition of rNCCT overlay map changed clinician’s initial read 64.4% of the time (95% CI 56-72%); the rNCCT identified new areas of ischemia not appreciated on blinded review 86.2% of the time (95% CI 78-92%) and in 35.1% helped rule out early ischemia where the reader was unsure of its presence (95% CI 26-45%). In the 53 patients with reperfusion and follow-up MRI, specificity of rNCCT for final lesion volume was 99.5% for rNCCT [98.5-99.8%] vs. 99.8% [IQR 98.8-99.9%] for CTP (P=0.08). Sensitivity for rNCCT was 19.9% [7.1-28.1%] vs. 17.5% [4.7-32.2%] for CTP (P=0.56). Conclusions: This study validates the rNCCT map for detection of early ischemic changes. It is more quantitative and objective than a clinician’s read of the NCCT alone. The sensitivity and specificity for detecting early ischemic changes on rNCCT were comparable to those achieved with CTP. This indicates that the rNCCT could be a valuable tool in the evaluation of acute stroke patients.

Elevated Circulating Endothelial Microparticles in Acute Stroke Patients: A Correlation with Brain Lesion Volume and Outcome.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3504-3504 ◽  
Author(s):  
Jan Simak ◽  
Monique P. Gelderman ◽  
Hua Yu ◽  
Violet Wright ◽  
Noah Alberts-Grill ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Hospital Discharge ◽  
Vascular Injury ◽  
Brain Lesion ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Disability Score ◽  
Ischemic Lesion ◽  
Blood Samples

Abstract Elevated endothelial cell membrane microparticles (EC MP) in blood have been demonstrated in various diseases with a vascular injury component. The aim of this study was to investigate if circulating EC MP show a relationship with outcome after acute stroke and with the ischemic brain lesion volume measured by magnetic resonance diffusion-weighted imaging (DWI). We analyzed EC MP in the blood of 42 acute stroke patients (AS): 20 patients with National Institutes of Health Stroke Scale (NIHSS) scores < 5 were classified as mild stroke (MS) (median NIHSS= 2; 25th–75th%: 0–2), while the other 22 patients with NIHSS ≥5 (NIHSS=12; 6–21) were classified as moderate to severe stroke (SS). Peripheral venous blood samples were collected at a median time of 36 hours (18–52) after the onset of clinical symptoms. The patients outcome was based on the Rankin disability score at the time of hospital discharge. Blood samples of 23 age matched control volunteers (CTRL) were used for comparison. EC MP analysis used a three-color flow cytometry assay (Simak et al, British J Haematol125, 804–813, 2004). EC MP were identified by antibodies to EC antigen CD105 (endoglin) and the highly specific CD144 (VE-cadherin). Platelet, white, and red blood cell MP were identified using cell specific antibodies to CD41, CD45, and CD235a, respectively. Plasma counts of CD105+CD41−CD45- EC MP were elevated in SS (median: 840/μL; 25th–75th%: 565–1079/μL) as compared to CTRL (415/μL; 201–624/μL; p=0.014). Moreover, CD105+CD144+ EC MP were elevated in SS (261/μL; 137–433/μL) when compared to MS (154/μL; 99–182/μL; p=0.031) or CTRL group (140/μL; 79–247/μL; p=0.031). Interestingly, CD105+CD41−CD45- EC MP, but not CD105+CD144+ EC MP, exhibited a significant correlation (p=0.005; r=0.45) with DWI brain lesion volume in AS group. However, CD105+CD144+ EC MP in the admission samples highly correlated (p=0.0007; r=0.54) with the Rankin disability score in the AS group at hospital discharge, while correlation of CD105+CD41−CD45- EC MP with the Rankin score was not as significant (p=0.007; r=0.44). We further analyzed 12 MS and 12 SS follow-up samples collected at a median period of 10 days (7–14) after the first sampling. Surprisingly, in SS follow-up samples, CD105+ EC MP populations decreased, while CD144+CD105−CD41- EC MP significantly increased, as compared to the samples at admission. In conclusion, the SS patient group had elevated different phenotypes of EC MP in the plasma samples at admission when compared to MS or CTRL groups. This is likely a reflection of the severity of ischemic-reperfusion injury of the brain vasculature. Elevated endoglin-positive EC MP were associated with brain ischemic lesion volume, whereas EC MP positive for both endoglin and VE-cadherin in the admission samples showed highly significant correlation with the patients disability outcome. The increased VE-cadherin-positive EC MP in follow-up samples may reflect a continuing endothelial injury in SS patients. Analysis of different phenotypes of EC MP in peripheral blood of stroke patients may be indicative of volume, character and severity of brain vascular injury and could be of diagnostic and prognostic use.

Abstract 2550: Early 3 Hour Imaging Demonstrates Substantial Diffusion Reversal with Lower Infarction Risk Compared to Tissue without Diffusion Reversal

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Hongyu An ◽  
Gyanendra Kumar ◽  
Katie D Vo ◽  
William J Powers ◽  
...  
Keyword(s):  
Lower Risk ◽  
Brain Regions ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Adc Value ◽  
Diffusion Weighted Images ◽  
Apparent Diffusion ◽  
Adc Values ◽  
Abnormal Tissue

Background: Literature suggests that diffusion reversal--determined by visually inspecting diffusion-weighted images which reverse on subsequent imaging--is uncommon. However, these studies performed the initial scan 3 to 6 hrs from onset which may miss lesions that have already undergone reversal. We measured apparent diffusion coefficient (ADC) reversal between 2 scans obtained at 3 and 6 hrs from onset comparing infarct probability in reversed regions to brain regions with persistent ADC lesions. Methods: Ischemic stroke patients underwent 3 MRI’s: <4.5 hrs (tp1), at 6 hrs (tp2), and at 1 mo (tp3) after onset. Co-registered maps measured ADC lesions (tp1, tp2) and FLAIR infarct (tp3). Diffusion lesions were manually outlined as hypointense regions on ADC. A population-derived ADC threshold to distinguish abnormal from normal ADC was calculated based on the maximum ADC value capturing >90% of voxels within the outlined lesions. ADC values less than or greater than this threshold were defined as abnormal and normal, respectively. ADC “reversal” was defined as voxels with abnormal tp1 ADC and normal tp2 ADC, whereas ADC “non-reversal” was defined as abnormal ADC on both tp1 and tp2. Final infarcts were outlined as hyperintense regions on tp3 FLAIR. Infarct probability (% of the tp1 ADC lesion which infarcted on tp3) was compared between reversed and non-reversed tissue using a Mann-Whitney test. Leukoariosis or CSF voxels due to infarct atrophy were excluded from the infarct analysis. Results: 39 patients were prospectively scanned at 2.8hr (tp1), 6.4hr (tp2), and 1mo (tp3) after stroke onset (NIHSS=14, 74% received tPA). The population-derived ADC threshold to distinguish between abnormal and normal was 71 × 10 -5 mm 2 /s. Median ADC lesion volume at tp1 was 34ml [15, 70] and at tp2 was 34ml [14, 65]. Median ADC reversal volume was 6.6ml [5, 17], accounting for 34% [11, 44] of the tp1 ADC lesion volume (ADC non-reversal volume was 21ml [6, 50]). 31 of 39 (79%) and 20 of 39 (51%) patients had reversal volumes >10% and >33% of their initial ADC lesion, respectively. Infarct probability was lower (57%) in ADC reversal tissue compared to tissue with non-reversal (82%, p<0.0001) ( Figure ). To confirm that the derived ADC threshold distinguished abnormal tissue on tp1 from normal tissue on tp2, ADC tp1 and tp2 values were compared and differed (66 vs. 77, p<0.0001). Conclusion: While ADC closely approximates infarct core, during early ischemia, a substantial proportion of the initial ADC lesion may reverse. Brain tissue with this MR signature carries a significantly lower risk of infarction than tissue without ADC reversal.

Abstract 2697: Fully-automated Identification of Acute Stroke Lesion Volumes with CT Perfusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Matus Straka ◽  
Gregory W Albers ◽  
Maarten G Lansberg ◽  
Stephanie M Kemp ◽  
Michael P Marks ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Automated Image Analysis ◽  
Great Promise ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Median Volume ◽  
Stroke Lesion ◽  
Volume Difference

Purpose: Mismatch between volumes of infarct core and critically hypoperfused tissue (CHT) may be used to identify acute stroke patients who could benefit from reperfusion therapies. We present a fully-automated, operator-free approach for identifying the core and CHT lesion volumes with CT perfusion (CTP). Methods: 31 scans of 25 acute stroke patients who underwent CTP followed by MRI (range: 23-120 min) were analyzed. CTP was obtained as a one or two 2cm slabs. MRI included DWI and PWI. Reference stroke lesion metrics were MRI-based: core via DWI (ADC<615x10 -6 mm 2 /s), and CHT via PWI (Tmax>6s). CTP and PWI scans were processed with an automated image analysis program (RAPID) with delay-independent deconvolution. MRI maps were coregistered to CTP. Contralaterally-relative CBV CT and CBF CT ( cr CBF CT , cr CBF CT ) maps were computed by putting into ratio the original and corresponding laterally-mirrored and smoothed rCBV CT and rCBF CT maps (obtained by vertical flip and coregistration of the anatomic images, see Fig). Stroke core in CTP was delineated by thresholding cr CBV CT and cr CBF CT , and CHT by thresholding Tmax CT . Optimal thresholds were obtained by ROC analysis and minimization of lesion volume differences between CT and MRI. Results: For identification of stroke core in CTP, cr CBF CT performed better than cr CBV CT . Optimal threshold was cr CBF CT < 0.30 with sensitivity 60% (CI 95% 57-63%) and specificity 88%, (CI 95% 87-89%); median volume difference between CBF CT and DWI lesions was 0 ml (IQR: -6ml to 6 ml); correlation of volumes was r 2 =0.72 ( p <0.0001). For identification of CHT, reference MRI lesions (Tmax MR >6s) were most accurately identified by Tmax CT >6s with sensitivity 72% (CI 95% 70-74%), specificity 97% (CI 95% 96-97%); median volume difference between Tmax CT and Tmax MR was -3ml (IQR: -10ml to 0ml); correlation of CHT volumes r 2 =0.89 (p<0.0001). Conclusions: The processing methods and CTP thresholds presented in this study show a great promise for fully-automated outlining of stroke lesions using CTP. Such a technique could be of great value for CTP-based patient selection in clinical trials and clinical practice.

Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke: the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS)

2021 ◽  
pp. neurintsurg-2021-018045
Author(s):  
Ilaria Casetta ◽  
Enrico Fainardi ◽  
Giovanni Pracucci ◽  
Valentina Saia ◽  
Stefano Vallone ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Case Fatality ◽  
Functional Independence ◽  
Primary Outcome Measure ◽  
Stroke Patients ◽  
Infarct Core ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracranial Hemorrhage ◽  
Contrast Ct

BackgroundClinical trials and observational studies have demonstrated the benefit of thrombectomy up to 16 or 24 hours after the patient was last known to be well. This study aimed to evaluate the outcome of stroke patients treated beyond 24 hours from onset.MethodsWe analyzed the outcome of 34 stroke patients (mean age 70.7±12.3 years; median National Institutes of Health Stroke Scale (NIHSS) score 13) treated with endovascular thrombectomy beyond 24 hours from onset who were recruited in the Italian Registry of Endovascular Thrombectomy in Acute Stroke. Selection criteria for patients were: pre-stroke modified Rankin scale (mRS) score of ≤2, non-contrast CT Alberta Stroke Program Early CT score of ≥6, good collaterals on single phase CT angiography (CTA) or multiphase CTA, and CT perfusion mismatch with an infarct core size ≤50% of the total hypoperfusion extent or involving less than one-third of the extent of the middle cerebral artery territory evaluated by visual inspection. The primary outcome measure was functional independence assessed by the mRS at 90 days after onset. Safety outcomes were 90 day mortality and the occurrence of symptomatic intracranial hemorrhage (sICH).ResultsSuccessful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was present in 76.5% of patients. Three month functional independence (mRS score 0–2) was observed in 41.1% of patients. The case fatality rate was 26.5%. and the incidence of sICH was 8.8%.ConclusionsThese findings suggest that, in a real world setting, very late endovascular therapy is feasible in appropriately selected patients.

scholarly journals Treatment with Diazepam in Acute Stroke Prevents Poststroke Seizures: A Substudy of the EGASIS Trial

2021 ◽  
pp. 1-6
Author(s):  
Julia H. van Tuijl ◽  
Elisabeth P.M. van Raak ◽  
Robert J. van Oostenbrugge ◽  
Albert P. Aldenkamp ◽  
Rob P.W. Rouhl
Keyword(s):  
Placebo Group ◽  
Acute Stroke ◽  
Incidence Rate Ratio ◽  
Day Treatment ◽  
Stroke Patients ◽  
Early Administration ◽  
Anterior Circulation ◽  
Double Blind

<b><i>Objective:</i></b> The frequency of seizures after stroke is high, with a severe impact on the quality of life. However, little is known about their prevention. Therefore, we investigated whether early administration of diazepam prevents the development of seizures in acute stroke patients. <b><i>Methods:</i></b> We performed a substudy of the EGASIS trial, a multicenter double-blind, randomized trial in which acute stroke patients were treated with diazepam or placebo for 3 days. Follow-up was after 2 weeks and 3 months. The occurrence of seizures was registered prospectively as one of the prespecified secondary outcomes. <b><i>Results:</i></b> 784 EGASIS patients were eligible for this substudy (389 treated with diazepam [49.6%] and 395 treated with placebo [50.4%]). Seizures were reported in 19 patients (2.4% of the total patient group). Seizures occurred less frequently in patients treated with diazepam (1.5 vs. 3.3% in the placebo group); however, this difference was only statistically significant in patients with a cortical anterior circulation infarction (0.9% in the diazepam group vs. 4.6% in the placebo group, incidence rate ratio 0.20, 95% CI: 0.05–0.78, <i>p</i> = 0.02, NNT = 27). <b><i>Conclusion:</i></b> We found that a 3-day treatment with diazepam after acute cortical anterior circulation stroke prevents the occurrence of seizures in the first 3 months following stroke.

Abstract WP47: Reperfusion Following Ischemic Stroke is Associated with Reduced Brain Edema

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hannah J Irvine ◽  
Thomas W Battey ◽  
Ann-Christin Ostwaldt ◽  
Bruce C Campbell ◽  
Stephen M Davis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Edema ◽  
Infarct Volume ◽  
Brain Magnetic Resonance Imaging ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Early Reperfusion ◽  
Echoplanar Imaging ◽  
Swelling Volume

Introduction: Revascularization is a robust therapy for acute ischemic stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. In stroke patients, early reperfusion consistently reduces infarct volume and improves long-term functional outcome, but there is little clinical data available regarding reperfusion edema. We sought to elucidate the relationship between reperfusion and brain edema in a patient cohort of moderate to severe stroke. Methods: Seventy-one patients enrolled in the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) with serial brain magnetic resonance imaging and perfusion-weighted imaging (PWI) were analyzed. Reperfusion percentage was calculated based on the difference in PWI lesion volume at baseline and follow-up (day 3-5). Midline shift (MLS) was measured on the day 3-5 fluid attenuated inversion recovery (FLAIR) sequence. Swelling volume and infarct growth volume were assessed using region-of-interest analysis on the baseline and follow-up DWI scans based on our prior methods. Results: Greater percentage of reperfusion was associated with less MLS (Spearman ρ = -0.46; P <0.0001) and reduced swelling volume (Spearman ρ = -0.56; P <0.0001). In multivariate analysis, reperfusion was an independent predictor of less MLS ( P <0.006) and decreased swelling volume ( P <0.0054), after adjusting for age, baseline NIHSS, admission blood glucose, baseline DWI volume, and IV tPA treatment. Conclusions: Reperfusion is associated with reduced brain edema as measured by MLS and swelling volume. While our data do not exclude the possibility of reperfusion edema in certain circumstances, in stroke patients, reperfusion following acute stroke is predominantly linked to less brain swelling.

Incorporation of relative cerebral blood flow into CT perfusion maps reduces false ’at risk' penumbra

2017 ◽  
Vol 10 (7) ◽  
pp. 657-662 ◽  
Author(s):  
Shlomi Peretz ◽  
David Orion ◽  
David Last ◽  
Yael Mardor ◽  
Yotam Kimmel ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Stroke ◽  
Ct Perfusion ◽  
False Negative ◽  
Stroke Patients ◽  
True Negative ◽  
True Negative Rate ◽  
Negative Rate ◽  
Perfusion Maps

PurposeThe region defined as ‘at risk’ penumbra by current CT perfusion (CTP) maps is largely overestimated. We aimed to quantitate the portion of true ‘at risk’ tissue within CTP penumbra and to determine the parameter and threshold that would optimally distinguish it from false ‘at risk’ tissue, that is, benign oligaemia.MethodsAmong acute stroke patients evaluated by multimodal CT (NCCT/CTA/CTP) we identified those that had not undergone endovascular/thrombolytic treatment and had follow-up NCCT. Maps of absolute and relative CBF, CBV, MTT, TTP and Tmax as well as summary maps depicting infarcted and penumbral regions were generated using the Intellispace Portal (Philips Healthcare, Best, Netherlands). Follow-up CT was automatically co-registered to the CTP scan and the final infarct region was manually outlined. Perfusion parameters were systematically analysed – the parameter that resulted in the highest true-negative-rate (ie, proportion of benign oligaemia correctly identified) at a fixed, clinically relevant false-negative-rate (ie, proportion of ‘missed’ infarct) of 15%, was chosen as optimal. It was then re-applied to the CTP data to produce corrected perfusion maps.ResultsForty seven acute stroke patients met selection criteria. Average portion of infarcted tissue within CTP penumbra was 15%±2.2%. Relative CBF at a threshold of 0.65 yielded the highest average true-negative-rate (48%), enabling reduction of the false ‘at risk’ penumbral region by ~half.ConclusionsApplying a relative CBF threshold on relative MTT-based CTP maps can significantly reduce false ‘at risk’ penumbra. This step may help to avoid unnecessary endovascular interventions.

Abstract TP63: Lacunarization After Endovascular Treatment: a Surrogate Marker of Good Functional Outcome

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Pedro Cardona ◽  
Helena Quesada ◽  
Blanca Lara ◽  
Nuria Cayuela ◽  
Xavier Ustrell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Surrogate Marker ◽  
Source Image ◽  
Stroke Patients ◽  
Good Functional Outcome ◽  
Lacunar Syndrome ◽  
Contrast Ct

Introduction: Multiple randomized trials have demonstrated that endovascular treatment (EVT) in selected stroke patients is associated with good clinical outcome (90 days mRankin 0-2: 44-60%). However the percentage of good functional outcome could be improved if we consider patients without cortical clinical impairment with presentation of classical lacunar syndrome despite non-lacunar radiological infarct. Methods: Consecutive patients with ischemic stroke who received endovascular reperfusion were retrospectively analyzed between May 2010 and April 2015. On admission NCCT (non-contrast CT) and CTASI (CT Angiography Source Image) were performed in stroke patients according to our hospital guidelines. We independently applied the ASPECT score in all baselines NCCT, CTASI and follow-up NCCT 24H, and magnetic resonance (MR) during hospitalization. Five pure clinical lacunar syndromes (CLS) were recorded within 24h exam after EVT in our stroke unit and 90 days follow-up Results: We review 428 thrombectomies of patients with acute ischemic stroke. Ninety-five percent of occlusions were located in middle cerebral artery or terminal internal carotid, (49% women, mean age 65+/-13 years; NIHSS at admission: 17; baseline mRS 0-1:96%). Successful recanalization (TICI 2b-3) was achieved in 81%. At 3 months good functional outcome (mRS 0-2) was seen in 51% and death occurred in 13%. CLS were indentified in 42% patients within 24h after EVT. This clinical syndromes were associated to ASPECT score in 24 NCCT and CTASI in patients with recanalization 2b-3 (p:0.003), but only 4% had a defined radiological lacunar stroke on MR. CLS turned out to be one of independence predictors of good outcomes (Rankin 0-2 at 90d) after adjustment for ages, sex and baseline NIHSS scores (OR 1.85; CI:1.4-3.1; p:0.001). Also CLS were still present in 34% of patients with Rankin>2 at 90d (Rankin 3:26%; Rankin 4:7%) Conclusions: These results suggest that a neurological exam 24h after EVT with identification of pure lacunar syndrome can predict favorable functional outcome at 90days. This group of patients presents radiological findings with an unusual location and size with regard to CLS. We suggest to consider patients with CLS as good outcome after EVT regardless 90d mRankin>2.

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

2020 ◽  
Vol 83 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Naveed Akhtar ◽  
Mahesh Kate ◽  
Saadat Kamran ◽  
Rajvir Singh ◽  
Zain Bhutta ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Short Term ◽  
Term Outcome ◽  
Contributory Factors ◽  
Short Term Outcome

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

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