Journal
STROKE AND VASCULAR NEUROLOGY
Volume 6, Issue 4, Pages 658-667Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/svn-2021-001032
Keywords
stroke; thrombectomy; thrombolysis
Categories
Funding
- National Institutes of Health [R01 NS105853]
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The article discusses the increasing interest and understanding in the histological composition of retrieved stroke emboli, particularly in its impact on mechanical thrombectomy procedures. However, the mechanisms underlying the low response to fibrinolytic therapy remain poorly understood. Analyzing the composition of clots with a focus on histological and ultrastructural characteristics offers unique insights into the mechanisms of resistance to fibrinolysis.
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.
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