Abstract
Response: We greatly appreciate the interest shown by Tsivgoulis and colleagues in their letter commenting on our recent article about the sex differences in the impact of metabolic syndrome (MetS) on the response to intravenous thrombolysis for acute middle cerebral artery (MCA) ischemic stroke.1 In our study, performed in a series of 125 consecutive patients with a documented acute MCA occlusion who were treated with intravenous tissue plasminogen activator (t-PA) according to SITS-MOST criteria, we observed that the effect of MetS enhancing the resistance to thrombolysis seemed to be more pronounced in women than in men.2 In this response we will try to address the valuable criticisms raised by Tsivgoulis et al in their letter. The first comment refers to the use of echo-contrast agents in patients without an adequate temporal acoustic window precluding transcranial Doppler (TCD) assessment of MCA. We agree with the authors that contrast agents influence residual flow signatures by artificially increasing velocities detected by TCD, the so-called “blooming effect.”3 This being true, we believe that this methodological issue is not likely to have …
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