Metabolic syndrome and resistance to IV thrombolysis in middle cerebral artery ischemic stroke.
OBJECTIVE
The metabolic syndrome (MetS) is a cluster of vascular risk factors associated with a prothrombotic state. We aimed to evaluate the impact of MetS on the response to systemic tPA treatment in patients with acute middle cerebral artery (MCA) ischemic stroke.


METHODS
We studied 100 consecutive patients with ischemic stroke with MCA occlusions on prebolus transcranial Doppler (TCD) examination treated with tPA following SITS-MOST criteria. MetS was diagnosed following AHA/NHLBI-2005 criteria. Resistance to thrombolysis was defined as the absence of TCD-assessed complete MCA recanalization 24 hours after tPA infusion. Infarct volume was measured on CT scans. Long-term clinical outcome was evaluated by the modified Rankin scale (mRS) score at day 90.


RESULTS
Fifty-eight (58%) patients fulfilled MetS criteria. Median prebolus NIH Stroke Scale score was 17. Forty (42%) patients showed resistance to clot dissolution, and 53 (53%) had poor clinical outcomes (mRS > 2). A multivariable-adjusted logistic regression model identified MetS as independently associated with resistance to thrombolysis (OR 4.7, 95% CI [1.7-13.6], p = 0.004). In the whole sample, MetS was associated with mRS > 2 (OR 2.4 [1.1-5.4], p = 0.03), although this association was no longer significant after multivariable adjustment. However, in patients with atherothrombotic stroke, MetS emerged as an independent predictor of poor long-term outcome (adjusted OR 13.9 [1.3-148.7], p = 0.02).


CONCLUSIONS
In our series, the metabolic syndrome was associated with a poor response to thrombolysis in patients with acute middle cerebral artery occlusions, as reflected by a higher resistance to clot dissolution.
Arenillas
J F
JF
Department of Neurosciences, Stroke Unit, Germans Trias i Pujol Universitary Hospital, Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain. juanfarenillas@gmail.com
Ispierto
L
L
Millán
M
M
Escudero
D
D
Pérez de la Ossa
N
N
Dorado
L
L
Guerrero
C
C
Serena
J
J
Castillo
J
J
Dávalos
A
A
D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D007262:Infusions, Intravenous; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D017585:Ultrasonography, Doppler, Transcranial
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator