Intra-arterial thrombolysis for acute ischemic stroke.

Intra-arterial thrombolysis, administered within six hours of symptoms onset, has been shown in a randomized, prospective, multicenter trial and in several nonrandomized case series to be beneficial in acute ischemic stroke caused by occlusion of the middle cerebral artery or its major divisions. Benefit has been reported in a relatively small number of nonrandomized case series beyond the six-hour time window in basilar artery occlusion. Although intra-arterial thrombolysis appears to be an effective and relatively safe form of therapy for certain patients with acute ischemic stroke, better outcomes and fewer side effects than currently reported are to be desired. Whether this will be achieved in part by a better selection of patients based on physiologic rather than chronologic criteria, by achieving higher and faster recanalization rates (through combined use of intra-arterial and intravenous therapy or through use of mechanical clot-dissolution devices), or by combining thrombolysis with neuroprotectant strategies remains to be established by future trials.