Sequential or Concurrent Thrombolysis and Thrombectomy

The rate of early recanalization, at 2–4 hours after treatment with IV alteplase, assessed with CT angiography, varies by vessel occlusion location and thrombus characteristics. With a large thrombus burden and occlusions of the internal carotid artery, early recanalization occurs in only 8%–10% of patients, while among patients with more distal occlusions or occlusions with thrombus showing contrast penetration (pervious thrombus), rates of recanalization are closer to 50%.^{1, 2} However, this is nowhere near the 90% reperfusion rates shown in recent endovascular thrombectomy (EVT) trials.³