Intra-arterial thrombolysis is a maturing treatment for acute thromboemboli
c stroke that shows promise in restoring cerebral blood supply. Reviewed ev
idence suggests that intra-arterial treatment has a longer window for treat
ment than intravenous t-PA and does improve outcome. A favorable outcome is
dependent on careful patient selection aimed at avoiding intracranial hemo
rrhage. This article describes features to evaluate for patient selection a
nd highlights factors along the treatment algorithm to maximize success.