Intravenous thrombolysis in acute ischemic stroke has a successful early recanalization rate below 50%, which is modulated by thrombus structure, fibrin compaction, and nonfibrin components.
Understanding the structural and compositional factors of thrombi that confer resistance to thrombolysis may guide the development of novel adjuvant therapies for acute ischemic stroke.
" was presented at the ISTH Congress in 2022. Intravenous thrombolysis (IVT) remains the only pharmacologic option to re-establish cerebral perfusion at the acute phase of ischemic stroke. IVT is based on the administration of recombinant tissue plasminogen activator with the objective of dissolving fibrin, the major fibrillar protein component of thrombi. Almost 30 years on from its introduction, although the clinical benefits of IVT have been clearly demonstrated, IVT still suffers from a relatively low efficacy, with a rate of successful early recanalization below 50% overall. Analyses of thrombectomy-recovered acute ischemic stroke (AIS) thrombi have shown that apart from occlusion site, thrombus length, and collateral status, AIS thrombus structure and composition are also important modulators of IVT efficacy. In this article, after a brief presentation of IVT principle and current knowledge on IVT resistance, we review recent findings on how compaction and structural alterations of fibrin together with nonfibrin thrombus components such as neutrophil extracellular traps and von Willebrand factor interfere with IVT in AIS. We further discuss how these new insights could soon result in the development of original adjuvant therapies for improved IVT in AIS. Finally, we summarize relevant new data presented during the 2022 ISTH Congress.
Ho‐Tin‐Noé et al. (Mon,) conducted a review in Acute ischemic stroke. Intravenous thrombolysis (IVT) was evaluated. Intravenous thrombolysis in acute ischemic stroke has a successful early recanalization rate below 50%, which is modulated by thrombus structure, fibrin compaction, and nonfibrin components.