TY - JOUR
T1 - Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke
T2 - Lessons from retrieved stroke emboli
AU - Brinjikji, Waleed
AU - Madalina Mereuta, Oana
AU - Dai, Daying
AU - Kallmes, David F.
AU - Savastano, Luis
AU - Liu, Yang
AU - Nimjee, Shahid M.
AU - Nogueira, Raul G.
AU - Abbasi, Mehdi
AU - Kadirvel, Ramanathan
N1 - Publisher Copyright:
©
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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.
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.
KW - stroke
KW - thrombectomy
KW - thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85111596472&partnerID=8YFLogxK
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U2 - 10.1136/svn-2021-001032
DO - 10.1136/svn-2021-001032
M3 - Review article
C2 - 34312319
AN - SCOPUS:85111596472
SN - 2059-8688
VL - 6
SP - 658
EP - 667
JO - Stroke and Vascular Neurology
JF - Stroke and Vascular Neurology
IS - 4
ER -