Advantages of a Combined Approach to Recanalization Therapy

To the Editor:We agree with Ciccone et al’s article regarding the myths of arterial therapy1 and Mattle’s accompanying editorial2 that advocates further controlled trials involving endovascular strategies in acute stroke. IV recombinant tissue plasminogen activator (rt-PA) therapy remains the standard of care for patients presenting within 3 hours of symptom onset. Yet, whereas 13% to 21% of patients will have recanalization of middle cerebral artery occlusions during the first hour of IV rt-PA treatment,3,4 patients with National Institutes of Health Stroke Scale (NIHSS) of 10 or greater often have …