{
  "abstract": "Mechanical thrombectomy (MT) has made macrovessel reopening achievable in acute ischemic stroke, but angiographic success does not ensure effective tissue-level reperfusion or microvascular oxygen delivery. This narrative review examines endothelial glycocalyx dysfunction as a plausible blood-facing interface that may connect pre-existing cardiometabolic vulnerability with post-thrombectomy microvascular dysfunction. Targeted English-language literature from PubMed/MEDLINE, Web of Science, Embase, and Google Scholar through 30 April 2026 was synthesized, with emphasis on MT, impaired microvascular reperfusion (IMR), no-reflow, blood–brain barrier (BBB) and neurovascular-unit (NVU) biology, glycocalyx-related biomarkers, cardiometabolic risk, perfusion imaging, and microcirculatory rescue. The evidence base is heterogeneous and is explicitly separated into direct human MT/LVO evidence, indirect human biomarker or imaging evidence, experimental cerebral evidence, non-cerebral/cross-disease vascular evidence, and hypothesis-generating mechanistic inference. Ischemic priming, abrupt reperfusion, oxidative and inflammatory stress, complement activation, metabolic stress, distal embolization, device-endothelial trauma, and host vulnerability may converge on the luminal endothelial surface. Glycocalyx dysfunction may amplify leukocyte adhesion and capillary plugging, platelet adhesion and microthrombosis, impaired mechanosensing and nitric-oxide signaling, BBB destabilization, and heterogeneous capillary flow; however, direct causal proof in human MT is lacking. Circulating syndecan-1, heparan sulfate, and hyaluronan are therefore best interpreted as time- and compartment-dependent systemic signals rather than direct readouts of the cerebral glycocalyx. Post-EVT microcirculatory rescue trials show that downstream perfusion may remain therapeutically actionable, but they do not demonstrate glycocalyx repair as the operative mechanism. A practical translational strategy is to combine serial, compartment-annotated biomarkers with prespecified early perfusion/barrier imaging and tissue endpoints, while explicitly modeling cardiometabolic vulnerability and competing microvascular mechanisms. The glycocalyx framework should therefore be considered a testable network hypothesis rather than an established primary cause of post-thrombectomy no-reflow or futile recanalization.",
  "abstract_shown": true,
  "affiliations": [
    "Clinical Medical College, Qinghai University",
    "Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Xusheng Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Sufu Mi"
    },
    {
      "affs": [
        0
      ],
      "name": "Jing Ma"
    },
    {
      "affs": [
        0
      ],
      "name": "Yue Xing"
    },
    {
      "affs": [
        0
      ],
      "name": "Guangbin Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Zongyu Cao"
    },
    {
      "affs": [
        1
      ],
      "name": "Xingjiang Xiong"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bgqtgn648jyvf.bib",
  "cited_by": 0,
  "doi": "10.3389/fneur.2026.1919445",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13732575/",
  "id": "bgqtgn648jyvf",
  "issns": [
    "1664-2295"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1919445/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7223138769",
  "pdf_url": "https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2026.1919445/pdf",
  "pmcid": "PMC13732575",
  "pmid": "42984971",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/bgqtgn648jyvf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:16Z",
      "native_id": "10.3389/fneur.2026.1919445",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1919445/full"
    },
    {
      "first_seen": "2026-11-08T12:22:32Z",
      "native_id": "PMC13732575",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fneur.2026.1919445"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Acute Ischemic Stroke Management",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Endothelial glycocalyx dysfunction in the setting of mechanical thrombectomy: a conceptual link between cardiometabolic vulnerability and microvascular reperfusion failure",
  "title_text": "Endothelial glycocalyx dysfunction in the setting of mechanical thrombectomy: a conceptual link between cardiometabolic vulnerability and microvascular reperfusion failure",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:22:32Z",
  "url": "https://research.draconitic.com/paper/bgqtgn648jyvf",
  "venue": "Frontiers in Neurology",
  "versions": []
}