Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: Lessons from retrieved stroke emboli

Waleed Brinjikji, Oana Madalina Mereuta, Daying Dai, David F. Kallmes, Luis Savastano, Yang Liu, Shahid M. Nimjee, Raul G. Nogueira, Mehdi Abbasi, Ramanathan Kadirvel

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)658-667
Number of pages10
JournalStroke and Vascular Neurology
Volume6
Issue number4
DOIs
StatePublished - Dec 1 2021

Keywords

  • stroke
  • thrombectomy
  • thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: Lessons from retrieved stroke emboli'. Together they form a unique fingerprint.

Cite this