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From Medscape today:

Intravenous Plus Intra-Arterial Thrombolysis Sometimes Helpful in Stroke

NEW YORK (Reuters Health) Jul 05 - Using a combination of intravenous (IV) and intra-arterial (IA) thrombolysis can be advantageous in certain patients with acute stroke, European researchers report in the July issue of Stroke.

Senior investigator Dr. Roman F. Sztajzel of University Hospital and Medical School, Geneva, Switzerland, told Reuters Health that "combined IV-IA versus IV thrombolysis guided by transcranial color-coded duplex sonography is feasible and safe."

"Recanalization after 30 minutes of intravenous thrombolysis led to a favorable outcome in about 60% of patients," he noted. However, "in the absence of early recanalization during IV thrombolysis, there is a clinical benefit to proceed to intra-arterial therapy for a significant proportion of patients."

Dr. Sztajzel and colleagues studied 33 patients, who, within 3 hours of symptom onset, underwent IV thrombolysis with tissue plasminogen activator. If this was not successful, they went on to IA thrombolysis.

At 3 months, 10 of the 17 patients (59%) in the IV group who had had complete or partial recanalization after 30 minutes of therapy had a favorable outcome. This was also the case in 9 of 16 patients (56%) who did not achieve such a result and went on to IA.

"These findings," concluded Dr. Sztajzel, "may support the systematic use of transcranial color-coded duplex sonography during thrombolysis in order to select patients without early recanalization for a more aggressive therapy such as intra-arterial thrombolysis."

Stroke 2006;37:1805-1809.