Our understanding of
cerebrovascular disease in women is hampered by a paucity of studies that include adequate numbers of female patients. Most studies are heavily biased toward men. Although women have fewer
strokes than men and have a better long-term prognosis after
strokes or TIAs,
cerebrovascular disease still affects large numbers of women. Presently, there is little convincing evidence that standard medical
therapy with
aspirin for prevention of
strokes in women is of benefit. Perhaps, inclusion of insufficient numbers of women in the
aspirin trials for symptomatic
carotid stenoses explains the apparent lack of therapeutic efficacy. Although
ticlopidine does not appear particularly promising for prevention of
stroke, other novel antiplatelet and
antithrombotic agents are being developed and need to be tested in women.
Carotid endarterectomy prevents
strokes in women and men, but women enjoy a lesser benefit; this appears to be true both for symptomatic and asymptomatic
carotid stenoses. Whereas restenosis is more common in women than men, most lesions remain asymptomatic. Surgery will probably remain the mainstay of treatment for
cerebrovascular disease in women and men, but in this era of "gender correctness," the striking absence of reliable data exclusively applicable to women confirms the need for additional studies.