Composición del trombo e implicaciones en la caracterización y el tratamiento en el ictus isquémico

Abstract

IntroductionSince mechanical thrombectomy has allowed ischemic stroke thrombi retrieval, its exhaustive study has involved a better knowledge of physiopathological processes implied in its formation. DevelopmentThrombotic pathways involved in the different vascular beds shared common mechanisms conditioning difficulties in the identification of specific patterns associated with stroke etiology. Other factors as clot formation time, associated inflammatory status or activation of additional immune and coagulation pathways (Neutrophil extracellular traps [NETs] delivery, platelet aggregation, endothelial activation and Von Willebrand Factor release) have been described as determinants in thrombus characteristics. In consequence, variable proportions of fibrin/platelet-rich and erythrocyte-rich areas coexist among the thrombus with a close relation within them, accompanied frequently by a protective outer shell with high concentrations of fibrin, NETs and Von Willebrand Factor. The presence of these components, as well as its distribution and interrelationships have demonstrated to have effect on thrombus resistance to revascularization treatments. An adequate knowledge of this pathways has allowed to develop adjuvant therapies capable of enhance current fibrinolytic drugs and/or increase efficacy of endovascular treatments. ConclusionThe knowledge of thrombus components and mechanisms involved in its formation open a potential way in ischemic stroke therapeutics with promising perspectives.