Top Things to Know: Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment
Published: June 13, 2022
Prepared by Anne Leonard MPH, BSN, RN, FAHA, Senior Science and Medicine Advisor - Lead
- There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT), since it has been established as standard of care recently, and as such, data for the role of sex in this area are even more scarce and conflicting
- This statement outlines the knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. This statement also provides a pragmatic roadmap for researchers who aim to investigate sex-and gender-related differences in EVT and for clinicians who wish to improve the clinical care of their EVT patients by addressing sex- and gender-specific factors.
- The definition of sex in this statement refers to biological factors, and in humans categorized as male or female, and is static (does not change over a person’s lifetime). Gender refers or is defined in terms of social roles, behaviors and expressions and includes gender identity, but also gender relations, role gender institutionalization and mainstreaming. These definitions are based on current data available.
- Some known sex differences in EVT are that women are on average older and are more likely to have pre-existing disabilities at the time of stroke onset. Some studies that suggest that women are undertreated in the acute phase of stroke, but other studies indicate comparable treatment for women as in men. Functional outcomes in women at 90 days and at one year after EVT are poorer for women as compared to men.
- Regarding differences in social or cultural roles related to sex or gender, being male or female can result in differences in access to health care, employment, financial autonomy, willingness to participate in research, and differences in power, all of which may impact post-EVT outcomes.
- Several questions targeted specifically to sex and gender differences are discussed in this statement. These include: What is the optimal EVT technique for women and do they differ from men? How does sex influence post-EVT outcomes? How can the influence of sex and gender be differentiated? How does sex influence access to EVT?
- This scientific statement describes a “Roadmap for Researchers” with key suggestions of how to approach this issue. Some concepts included: Sex vs. Gender, Stroke etiology, baseline status prior to EVT, neuroimaging and EVT technique, outcomes and treatment effect.
- This scientific statement also includes key suggestions for clinicians that cross several areas such as: the acute phase of care (e.g. delay any decision to proceed with palliative care), and the non-acute phase of care (e.g. for patients at high risk of stroke or past stroke, discuss what they consider an acceptable outcome in case of stroke and draft a living will based on these discussions).
- Sex may influence stroke risk, acute EVT management and post- EVT outcomes.
- Stroke researchers need to be aware of the profound impact of sex on their research (e.g. missing sex-related phenomena in their data) and clinicians need to understand the importance of sex and sex-related biases in their daily clinical practice in order to tailor their clinical care towards the specific needs of their EVT patients.
Citation
Ospel JM, Schaafsma JD, Leslie-Mazwi TM, Amin-Hanjani S, Asdaghi N, Gordon-Perue GL, Couillard P, Hadidi NN, Bushnell C, McCullough LD, Goyal M; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; and Council on Epidemiology and Prevention. Toward a better understanding of sex- and gender-related differences in endovascular stroke treatment: a scientific statement from the American Heart Association/American Stroke Association [published online ahead of print June 13, 2022]. Stroke. doi: 10.1161/STR.0000000000000411