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

Stroke and Vascular Neurology

article

Waleed Brinjikji¹  Oana Madalina Mereuta¹  Daying Dai¹  David F Kallmes¹  Luis Savastano²  Yang Liu¹  Shahid M Nimjee³  Raul G Nogueira⁴  Mehdi Abbasi¹  Ramanathan Kadirvel¹ 

[1] Radiology , Mayo Clinic;Neurosurgery , Mayo Clinic;Neurosurgery , Ohio State University Medical Center;Neurology , Emory University School of Medicine

关键词: stroke;    thrombectomy;    thrombolysis;   

DOI  :  10.1136/svn-2021-001032

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

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.strokethrombectomythrombolysishttp://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND