ABSTRACT
In the 1980s, several reports of intra-arterial (IA) thrombolysis therapy in acute ischemic stroke were published.1-3 The thrombolytic agents used in these early case series were urokinase (UK) and streptokinase (SK). Studies of IA thrombolysis for acute ischemic stroke were initially limited to uncontrolled protocols.4,5 There was great variability in technique, and efficacy and complication rates varied among the reported series. As a result, in 1996, an American Heart Association (AHA) Special Writing Group published its recommendations for the use of thrombolytics in acute ischemic stroke. Based on the strength of the scientific evidence available at that time, the AHA concluded that IA thrombolysis ‘should be considered investigational and only used in the clinical trial setting’ and recommended ‘further testing of ’ IA thrombolysis.6 Advances in microcatheter technology during the 1980s allowed superselective catheterization of even distal branches of occluded intracranial vessels.
