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 ...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.展开更多
Objective To systematically analyse prior reports of carotid endarterectomy(CEA)performed in cases of≤50%carotid stenosis in order to understand patient tolerance and potential benefit.Methods A systematic review and...Objective To systematically analyse prior reports of carotid endarterectomy(CEA)performed in cases of≤50%carotid stenosis in order to understand patient tolerance and potential benefit.Methods A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.An English-language search was performed of online databases using librarian-selected search terms.Abstracts were reviewed for relevance which included mention of carotid endarterectomy and stenosis.Prospective or retrospective observational cohort studies that reported series of patients who underwent endarterectomy for minimal(≤50%)luminal stenosis with reported outcomes were included.Results Six studies(which included our institutional series)with a total of 143 patients met the inclusion criteria.The weighted mean age at the time of CEA was 72.3 years;113(79.0%)were male.55.8%of patients with available data had recurrent ipsilateral ischaemic events despite medical therapy.Two patients out of 129 with available perioperative data(1.6%)had perioperative MRI findings of acute ischaemic stroke,both within the hemisphere contralateral to the side of CEA.Of the 138 patients with available follow-up(mean,36 months),none had recurrent ipsilateral ischaemic events.Conclusions Endarterectomy for symptomatic carotid disease causing≤50%stenosis may be a potentially beneficial strategy to prevent stroke recurrence.Studies with robust methodology are needed to draw more definitive conclusions in terms of the safety and efficacy of endarterectomy for minimal stenosis with vulnerable features relative to intensive medical therapy.展开更多
基金This work was supported by the National Institutes of Health grant number(R01 NS105853).
文摘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.
文摘Objective To systematically analyse prior reports of carotid endarterectomy(CEA)performed in cases of≤50%carotid stenosis in order to understand patient tolerance and potential benefit.Methods A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.An English-language search was performed of online databases using librarian-selected search terms.Abstracts were reviewed for relevance which included mention of carotid endarterectomy and stenosis.Prospective or retrospective observational cohort studies that reported series of patients who underwent endarterectomy for minimal(≤50%)luminal stenosis with reported outcomes were included.Results Six studies(which included our institutional series)with a total of 143 patients met the inclusion criteria.The weighted mean age at the time of CEA was 72.3 years;113(79.0%)were male.55.8%of patients with available data had recurrent ipsilateral ischaemic events despite medical therapy.Two patients out of 129 with available perioperative data(1.6%)had perioperative MRI findings of acute ischaemic stroke,both within the hemisphere contralateral to the side of CEA.Of the 138 patients with available follow-up(mean,36 months),none had recurrent ipsilateral ischaemic events.Conclusions Endarterectomy for symptomatic carotid disease causing≤50%stenosis may be a potentially beneficial strategy to prevent stroke recurrence.Studies with robust methodology are needed to draw more definitive conclusions in terms of the safety and efficacy of endarterectomy for minimal stenosis with vulnerable features relative to intensive medical therapy.
