Arenillas JF et al. (2008) Metabolic syndrome and resistance to IV thrombolysis in middle cerebral artery ischemic stroke. Neurology 71: 190–195

Metabolic syndrome—a combination of factors that increase the risk of developing cardiovascular disease and diabetes—is associated with a prothrombotic state. Arenillas and colleagues have proposed that, in patients with acute ischemic stroke, the metabolic syndrome might have a negative effect on outcome and could lead to resistance to thrombolysis therapy.

The Spanish team analyzed data on 100 patients (mean age 67.9 ± 10.5 years, 65% male) with acute middle cerebral artery ischemic stroke, 58 of whom also had the metabolic syndrome. All patients were treated with intravenous tissue plasminogen activator. Resistance to thrombolysis, defined as failure to recanalize within 24 h, occurred in 40 patients (33 with the metabolic syndrome, 7 without). A poor long-term outcome (modified Rankin scale score >2 at day 90) was more common in patients with the metabolic syndrome than in those without it (62.1% vs 40.5%). In a subgroup of patients with atherothrombotic stroke, metabolic syndrome independently predicted high resistance to thrombolysis and poor long-term outcome. The team noted that hyperglycemia and insulin resistance components of the metabolic syndrome seemed to be responsible for the limited efficacy of thrombolysis.

Arenillas et al. conclude that diagnosis of metabolic syndrome might help to identify a subgroup of patients who could have a poor response to tissue plasminogen activator therapy. These patients could instead be considered for aggressive reperfusion treatments.