Stroke is a leading cause of death and disability worldwide. Women are disproportionately affected by stroke, exhibiting higher mortality and disability rates post-stroke than men. Clinical stroke research has historically included mostly men and studies were not properly designed to perform sex- and gender-based analyses, leading to under-appreciation of differences between men and women in stroke presentation, outcomes, and response to treatment. Reasons for these differences are likely multifactorial; some are due to gender-related factors (i.e. decreased social support, lack of stroke awareness), yet others result from biological differences between sexes. Unlike men, women often present with ‘atypical’ stroke symptoms. Lack of awareness of ‘atypical’ presentation has led to delays in hospital arrival, diagnosis, and treatment of women. Differences also extend to carotid atherosclerotic disease, a cause of stroke, where plaques isolated from women are undeniably different in morphology/composition compared to men. As a result, women may require different treatment than men, as evidenced by the fact that they derive less benefit from carotid revascularization than men but more benefit from medical management. Despite this, women are less likely than men to receive medical therapy for cardiovascular risk factor management. This review focuses on the importance of sex and gender in ischaemic stroke and carotid atherosclerotic disease, summarizing the current evidence with respect to (i) stroke incidence, mortality, awareness, and outcomes, (ii) carotid plaque prevalence, morphology and composition, and gene connectivity, (iii) the role of sex hormones and sex chromosomes in atherosclerosis and ischaemic stroke risk, and (iv) carotid disease management.

中文翻译：

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性和性别在缺血性中风和颈动脉粥样硬化疾病中的重要性

中风是全球死亡和残疾的主要原因。女性受中风的影响尤为严重，中风后死亡率和残疾率高于男性。临床卒中研究历来主要包括男性，研究设计不当，无法进行基于性和性别的分析，导致人们低估了男性和女性在卒中表现、结果和治疗反应方面的差异。这些差异的原因可能是多方面的；有些是由于与性别有关的因素（即社会支持减少、缺乏中风意识），还有一些是由于两性之间的生物学差异。与男性不同，女性经常出现“非典型”中风症状。缺乏对“非典型”表现的认识导致妇女的入院、诊断和治疗出现延误。差异还延伸到颈动脉粥样硬化疾病，这是中风的一个原因，与男性相比，从女性身上分离出的斑块在形态/组成上无疑是不同的。因此，女性可能需要与男性不同的治疗，事实证明，与男性相比，她们从颈动脉血运重建中获益较少，但从医疗管理中获益更多。尽管如此，女性接受心血管危险因素管理药物治疗的可能性低于男性。本综述侧重于性和性别在缺血性中风和颈动脉粥样硬化疾病中的重要性，总结了关于 (i) 中风发病率、死亡率、意识和结果，(ii) 颈动脉斑块患病率、形态和组成，以及基因连通性，