RT Journal Article
SR Electronic
T1 Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: lessons from retrieved stroke emboli
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP svn-2021-001032
DO 10.1136/svn-2021-001032
A1 Brinjikji, Waleed
A1 Madalina Mereuta, Oana
A1 Dai, Daying
A1 Kallmes, David F
A1 Savastano, Luis
A1 Liu, Yang
A1 Nimjee, Shahid M
A1 Nogueira, Raul G
A1 Abbasi, Mehdi
A1 Kadirvel, Ramanathan
YR 2021
UL http://svn.bmj.com/content/early/2021/07/25/svn-2021-001032.abstract
AB There has been growing interest and insight into the histological composition of retrieved stroke emboli. One of the main focuses of the stroke clot analysis literature has been the implications of clot composition on mechanical thrombectomy procedures. However, the holy grail of clot analysis may not be in the field of clot–device interaction, but rather, in understanding mechanisms of fibrinolysis resistance. The mechanisms underlying the low response to fibrinolytic therapy, even with the newer, more powerful agents, remain poorly understood. While factors such as embolus size, location and collateral status influence alteplase delivery and recanalisation rates; compositional analyses focused on histological and ultrastructural characteristics offer unique insights into mechanisms of alteplase resistance. In this review, we strive to provide comprehensive review of current knowledge on clot composition and ultrastructural analyses that help explain resistance to fibrinolysis.