Department of Neurology, University Hospital Bern, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland.
Stroke. 2010 Nov;41(11):2693-6. doi: 10.1161/STROKEAHA.110.594036. Epub 2010 Oct 14.
Randomized trials suggested a different benefit of intravenous thrombolysis (IVT) and intra-arterial thrombolysis (IAT) between men and women with anterior circulation stroke because of a worse outcome of women in the control group.
We compared outcome and recanalization in men and women with basilar artery occlusion treated with antithrombotic treatment alone, IVT or combined IVT-IAT, or IAT in the Basilar Artery International Cooperation Study.
Overall, 389 male and 226 female patients were analyzed. In the antithrombotic treatment group, 68 of 111 (61%) men and 47 of 70 (67%) women had a poor outcome defined as a modified Rankin Scale score of 4 to 6 (adjusted risk ratio [aRR], 0.96; 95% CI, 0.75 to 1.24), in the IVT/combined IVT-IAT group, 47 of 77 (61%) men and 24 of 43 (56%) women (aRR, 1.19; 95% CI, 0.89 to 1.60), and in the IAT group, 142 of 185 (77%) men and 71 of 102 (70%) women (aRR, 1.01; 95% CI, 0.88 to 1.17). Mortality was not different between men and women in the antithrombotic treatment group (aRR, 0.80; 95% CI, 0.55 to 1.16), the IVT/combined IVT-IAT group (aRR, 1.11; 95% CI, 0.72 to 1.73), or in the IAT group (aRR, 1.01; 95% CI, 0.75 to 1.36). Insufficient recanalization after combined IVT-IAT or IAT was similar in men and women (23% versus 22%; aRR, 0.92; 95% CI, 0.58 to 1.46).
In patients with acute basilar artery occlusion, no significant gender differences for outcome and recanalization were observed, regardless of treatment modality.
随机试验表明，由于对照组女性的结局较差，男性和女性前循环卒中患者静脉溶栓（IVT）和动脉内溶栓（IAT）的获益不同。
我们比较了基底动脉闭塞患者接受单纯抗栓治疗、IVT 或 IVT+IAT 联合治疗、或 IAT 治疗的男性和女性的结局和再通情况，这些患者均来自于基底动脉国际合作研究。
总共分析了 389 名男性和 226 名女性患者。在抗栓治疗组中，111 例患者中有 68 例（61%）男性和 70 例患者中有 47 例（67%）女性结局较差（定义为改良 Rankin 量表评分 4-6 分）；在 IVT+联合 IVT+IAT 组中，77 例患者中有 47 例（61%）男性和 43 例患者中有 24 例（56%）女性（调整风险比[aRR]，0.96；95%CI，0.75 至 1.24）；在 IAT 组中，185 例患者中有 142 例（77%）男性和 102 例患者中有 71 例（70%）女性（aRR，1.01；95%CI，0.88 至 1.17）。抗栓治疗组（aRR，0.80；95%CI，0.55 至 1.16）、IVT+联合 IVT+IAT 组（aRR，1.11；95%CI，0.72 至 1.73）或 IAT 组（aRR，1.01；95%CI，0.75 至 1.36）中，男性和女性的死亡率无差异。联合 IVT+IAT 或 IAT 后再通不足在男性和女性中相似（23%比 22%；aRR，0.92；95%CI，0.58 至 1.46）。
在急性基底动脉闭塞患者中，无论治疗方式如何，均未观察到结局和再通方面的显著性别差异。
