Intra-arterial Thrombolytics for Treatment of Acute Ischemic Stroke

Intra-arterial (IA) thrombolytic drugs were used as a primary therapy for recanalization of large vessel occlusions (LVO) with limited success. In recent years, endovascular interventions for the treatment of acute ischemic stroke (AIS) have rapidly evolved to include newer stentriever devices, which are now considered the standard of care for the treatment of AIS secondary to LVO. Although MT with stentriever technology has led to superior reperfusion rates, less than one third of patients achieve complete reperfusion. The role of thrombolytics in modern AIS endovascular therapy is undefined. However, new research suggests that IA thrombolytic use with MT may be beneficial in improving revascularization rates in AIS patients. Large series have shown that IA thrombolysis can be used as an adjunct/rescue therapy to MT, without increasing the risk of symptomatic intracerebral hemorrhage. In this chapter, we provide a brief history of IA thrombolytics, current approaches, and their potential role in modern endovascular therapy.