Felix Ng, Chengchuan Wu, Ángel Chamorro, Wenjie Zi, Xiaochuan Huo, Bernard Yan, Yamei Tang, Raul G Nogueira, Zhenhua Zhou, Urs Fischer, Johannes Kaesmacher, Benjamin Gory, Guillaume Turc, Sébastien Richard, Peter Mitchell, Bruce C V Campbell
Suboptimal clinical outcomes are common after ischemic stroke with large vessel occlusion despite current reperfusion treatment with intravenous thrombolysis and mechanical thrombectomy. Targeting residual distal arterial and microvascular occlusions with intraarterial thrombolysis has recently gained substantial interest as an adjunct to improve cerebral tissue perfusion. While recent trials provide promise in selected patients with anterior-circulation stroke, further high-quality, large-scale studies and pooled individual-patient analyses are needed. This review summarizes the evolving role of intraarterial thrombolysis over the past 3 decades and projects potential developments.