Combined intravenous and intra-arterial approach in acute stroke treatment

Despite the significant improvement in the outcome of ischaemic stroke with the use of intravenous recombinant tissue plasminogen activator, experience has shown limitations of the sole use of this approach in acute stroke treatment. This has encouraged the search for alternative managements for acute stroke. The combined use of intravenous/intra-arterial therapy is one such alternate treatment, if used in the right setting. In this review, the authors discuss the advantages and limitations of using this approach, together with an overview of the available therapies used through each route. The authors discuss the process of patient selection using clinical, as well as state of the art imaging modalities.