TY - JOUR 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 SP - 658 LP - 667 DO - 10.1136/svn-2021-001032 VL - 6 IS - 4 AU - Waleed Brinjikji AU - Oana Madalina Mereuta AU - Daying Dai AU - David F Kallmes AU - Luis Savastano AU - Yang Liu AU - Shahid M Nimjee AU - Raul G Nogueira AU - Mehdi Abbasi AU - Ramanathan Kadirvel Y1 - 2021/12/01 UR - http://svn.bmj.com/content/6/4/658.abstract 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. ER -