title: The metabolic syndrome is associated with a higher resistance to intravenous thrombolysis for acute ischemic stroke in women than in men.
abstract: OBJECTIVE
  The metabolic syndrome (MetS) might confer a higher resistance to intravenous thrombolysis in acute middle cerebral artery (MCA) ischemic stroke. MetS increases the risk of stroke in women to a greater extent than in men. We aimed to investigate whether there might be sex differences in the impact of MetS on the response to intravenous thrombolysis for acute MCA ischemic stroke.
  
  
  METHODS
  We prospectively studied consecutive ischemic stroke patients, treated with intravenous tissue-type plasminogen activator according to SITS-MOST criteria, with an MCA occlusion on prebolus transcranial Doppler examination. Resistance to thrombolysis was defined as the absence of complete MCA recanalization 24 hours after tissue-type plasminogen activator infusion by transcranial Doppler criteria. MetS was diagnosed according to the criteria established by the American Heart Association/National Heart, Lung, and Blood Institute 2005 statement.
  
  
  RESULTS
  A total of 125 patients (75 men, 50 women; mean age, 67.6+/-11 years) were included. MetS was diagnosed in 76 (61%) patients. Resistance to clot lysis at 24 hours was observed in 53 (42%) patients. Two multivariate-adjusted, logistic-regression models identified that MetS was associated with a higher resistance to tissue-type plasminogen activator, independently of other significant baseline variables (odds ratio=9.8; 95% CI, 3.5 to 27.8; P=0.0001) and of the individual components of the MetS. The MetS was associated with a significantly higher odds of resistance to thrombolysis in women (odds ratio=17.5; 95% CI, 1.9 to 163.1) than in men (odds ratio=5.1; 95% CI, 1.6 to 15.6; P for interaction=0.0004).
  
  
  CONCLUSIONS
  The effect of MetS on the resistance to intravenous thrombolysis for acute MCA ischemic stroke appears to be more pronounced in women than in men.
authors.affiliation: Department of Neurology, Stroke Unit, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain. juanfarenillas@gmail.com
authors.forename: Juan F
authors.initials: JF
authors.lastname: Arenillas
authors.forename: Patricio
authors.initials: P
authors.lastname: Sandoval
authors.forename: Natalia
authors.initials: N
authors.lastname: Pérez de la Ossa
authors.forename: Mónica
authors.initials: M
authors.lastname: Millán
authors.forename: Cristina
authors.initials: C
authors.lastname: Guerrero
authors.forename: Domingo
authors.initials: D
authors.lastname: Escudero
authors.forename: Laura
authors.initials: L
authors.lastname: Dorado
authors.forename: Elena
authors.initials: E
authors.lastname: López-Cancio
authors.forename: José
authors.initials: J
authors.lastname: Castillo
authors.forename: Antoni
authors.initials: A
authors.lastname: Dávalos
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D004351:Drug Resistance; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D020768:Middle Cerebral Artery / Q000473:pathology; D016017:Odds Ratio; D010960:Plasminogen Activators / Q000627:therapeutic use; D011446:Prospective Studies; D012727:Sex Characteristics; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D005343:Fibrinolytic Agents; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator