| Metabolic syndrome and resistance to IV thrombolysis in middle cerebral artery ischemic stroke. | |
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MedLine Citation:
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PMID: 18625965 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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). CONCLUSION: 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. |
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Authors:
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J F Arenillas; L Ispierto; M Millán; D Escudero; N Pérez de la Ossa; L Dorado; C Guerrero; J Serena; J Castillo; A Dávalos |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Neurology Volume: 71 ISSN: 1526-632X ISO Abbreviation: Neurology Publication Date: 2008 Jul |
Date Detail:
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Created Date: 2008-07-15 Completed Date: 2008-08-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: United States |
Other Details:
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Languages: eng Pagination: 190-5 Citation Subset: AIM; IM |
Affiliation:
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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 |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Brain Ischemia / complications*, drug therapy, physiopathology* Female Fibrinolytic Agents / administration & dosage, therapeutic use Humans Infarction, Middle Cerebral Artery / complications*, drug therapy, physiopathology* Infusions, Intravenous Male Metabolic Syndrome X / complications*, drug therapy, physiopathology* Middle Aged Prospective Studies Retrospective Studies Risk Factors Thrombolytic Therapy* / adverse effects, methods Tissue Plasminogen Activator / administration & dosage*, therapeutic use Ultrasonography, Doppler, Transcranial |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator |
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