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.

中文翻译：

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急性缺血性卒中纤溶阻力的机制和溶栓的潜在靶点：从回收的卒中栓子中汲取的教训

人们对检索到的中风栓子的组织学组成越来越感兴趣和深入了解。中风凝块分析文献的主要焦点之一是凝块成分对机械血栓切除术的影响。然而，凝块分析的圣杯可能不在凝块-装置相互作用领域，而是在了解纤溶阻力的机制。即使使用更新、更强大的药物，对纤溶治疗反应低下的机制仍然知之甚少。虽然栓子大小、位置和侧支状态等因素会影响阿替普酶的给药和再通率；以组织学和超微结构特征为重点的成分分析为阿替普酶耐药机制提供了独特的见解。在本次审查中，