6 mg/kg. In our analysis, sICH rates were not higher

in patients who were treated with full-dose IV rt-PA than in those treated with partial dose prior to endovascular therapy. The lack of difference in sICH rates could be related to the short half-life of IV rt-PA (3-5 minutes),15 which means that the thrombolytic effect would wane prior to the endovascular intervention. Moreover, in patients who have received full-dose IV rt-PA, smaller doses of IA thrombolytics are administered with greater emphasis on mechanical thrombectomy. It is also possible that the occurrence of sICH depends more on factors such as magnitude of ischemic injury and blood–brain barrier disruption rather than the dose of thrombolytics.16 Although we observed that the patients treated with .9 click here mg/kg IV rt-PA had a significantly higher rate of favorable outcomes, we believe that prospective studies ensuring randomization with uniform RXDX-106 cell line outcome ascertainment are required in order to confirm this finding. Future studies should also address the optimal dosing of thrombolytic medications in IA procedures following .9 mg/kg IV rt-PA. The implication of our findings for current clinical practice is that patients who have been treated with full-dose IV rt-PA can be considered for endovascular treatment under well-defined

protocols. Our study has several limitations that must be considered prior to interpretation of the results. This was a meta-analysis combining the data of several case series with variable methodologies. MCE The methodology and ascertainment of outcomes may have been more rigorous in the .6 mg/kg group (ascertainment bias) where 2 case series were derived from studies that were conducted as clinical trials. Outcome estimates were heterogeneous across studies that used the same treatment regimen. This was likely due to discrepancies in the definition of outcome measures and in the time points of data ascertainment. Furthermore, the variations in endovascular techniques and doses of IA thrombolytics induce additional heterogeneity in

angiographic and clinical outcomes. While the numbers of patients in the studies were too small to perform subgroup analysis, we provided descriptive statistics in Tables 1 and 2 to facilitate interpretation. Because individual patient data were not available, we were unable to control for important prognostic factors such as patient age, time to treatment, NIHSS score at presentation, site of arterial occlusion, and technique of endovascular treatment (confounding bias). Meta-analyses are prone to publication bias. We therefore applied the trim and fill method which did not support the presence of substantial bias. Our analysis suggests that using .9 mg/kg as opposed to .6 mg/kg of IV rt-PA prior to endovascular treatment is safe and associated with higher recanalization rates and functional outcome.