Intra-arterial thrombolysis

Image from http://www.ajnr.org/content/33/7/1292/F1: The article is called

Reperfusion Rates Following Intra-Arterial Thrombolysis for Acute Ischemic Stroke: The Influence of the Method for Alteplase Delivery (2012) G.A. Christoforidis, A. Slivka, Y. Mohammad, C. Karakasis, M. Kontzialis and M. Khadir

In a previous post I wrote about thrombolysis, a method where a medication for dissolving blood clots, the most common one used at the moment is known as alteplase. The most common delivery method at the moment is intravenously. Now I would like to explain an alternative form of reperfusion therapy (in total I'm going to talk about three methods). Intra-arterial thrombolysis (IAT) involves delivering the same medications used in IV-rtPA (alteplase) by inserting a catheter into the blocked artery and delivering the rtPA directly into the clot. This method is said to be significantly more effect than IV rtPA and reduced the risk of bleeding/systemic side effects.
The barriers for providing IAT vs IV rtPA is that it requires more time, there is longer time between arriving in the emergency department and receiving treatment. IAT does have a larger window to treat because of the reduced risk of bleeding, patients can receive it up to 6 hours after the onset of stroke vs 4.5 hours with rtPA. This technique also requires additional specialised staff and equipment.