Related Experiment Video

Updated: Jul 14, 2026

Prehospital Thrombolysis: A Manual from Berlin
05:52

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Debunking 7 myths that hamper the realization of randomized controlled trials on intra-arterial thrombolysis for

Alfonso Ciccone1, Luca Valvassori, Roberto Gasparotti

  • 1Stroke Unit and Department of Neurology, Niguarda Ca' Granda Hospital, Milan, Italy. Alfonso.Ciccone@ospedaleniguarda.it

Stroke
|June 2, 2007
PubMed

Insights

Intra-arterial (IA) thrombolysis for ischemic stroke is common but lacks strong evidence. Current beliefs about its superiority over intravenous (IV) thrombolysis are often myths, hindering informed treatment decisions.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Emergency Medicine

Background:

  • Intravenous (IV) thrombolysis is the standard for ischemic stroke within 3 hours.
  • Intra-arterial (IA) thrombolysis has been used for over 25 years, but evidence supporting its superiority is limited.
  • Clinical decisions regarding IA thrombolysis are often based on beliefs rather than robust data.

Purpose of the Study:

  • To analyze the beliefs and myths surrounding patient selection for IA thrombolysis.
  • To critically evaluate the perceived advantages of IA thrombolysis over IV thrombolysis.

Main Methods:

  • Review and debunk common myths regarding IA thrombolysis efficacy and patient selection.
  • Examined beliefs about higher recanalization rates, effectiveness beyond the 3-hour window, and use in specific stroke types (vertebrobasilar).
  • Assessed myths related to diagnostic screening methods (Doppler, CTA, MRA, MRI) and its role as rescue therapy.

Main Results:

  • Identified and debunked seven common myths about IA thrombolysis.
  • Found that evidence supporting IA thrombolysis superiority over IV is scant.
  • Highlighted that efficacy is often mythologized and not dependent on specific agents or devices.

Conclusions:

  • There is a lack of robust evidence for IA thrombolysis in acute stroke management.
  • Clinicians and patients lack sufficient information for informed treatment choices.
  • Randomized controlled trials are needed to resolve uncertainties; current case series have perpetuated myths.
Abstract

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