Background And Purpose: Functional outcomes after ischaemic stroke are worse in women, despite adjusting for differences in comorbidities and treatment approaches. White matter microvascular integrity represents one risk factor for poor long-term functional outcomes after ischaemic stroke. The aim of the study is to characterise sex-specific differences in microvascular integrity in individuals with acute ischaemic stroke.

Methods: A retrospective analysis of subjects with acute ischaemic stroke and brain MRI with diffusion-weighted (DWI) and dynamic-susceptibility contrast-enhanced (DSC) perfusion-weighted imaging obtained within 9 hours of last known well was performed. In the hemisphere contralateral to the acute infarct, normal-appearing white matter (NAWM) microvascular integrity was measured using the coefficient and apparent diffusion coefficient (ADC) values. Regression analyses for predictors of coefficient, DWI volume and good outcome (90-day modified Rankin scale (mRS) score <2) were performed.

Results: 105 men and 79 women met inclusion criteria for analysis. Despite no difference in age, women had increased NAWM coefficient (1027.4 vs 692.7×10/s; p=0.006). In women, atrial fibrillation (β=583.6; p=0.04) and increasing NAWM ADC (β=4.4; p=0.02) were associated with increased NAWM coefficient. In multivariable regression analysis, the coefficient was an independent predictor of DWI volume in women (β=0.007; p=0.01) but not men.

Conclusions: In women with acute ischaemic stroke, increased NAWM coefficient is associated with increased infarct volume and chronic white matter structural integrity. Prospective studies investigating sex-specific differences in white matter microvascular integrity are needed.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979874PMC
http://dx.doi.org/10.1136/svn-2019-000268DOI Listing

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