intravenous v intrarterial (bridging) lysis therapy

data of IMS investigators, reported in Stroke 2004. The outcomes overtly appear the same. Percent with modified Rankin of 0-1 at 90 days was 30 % in IMS group, 32 % in iv tpa group. The respective percentages for NIHSS less than 1 at 90 days was 28 and 25 %; Barthel index 95 or 100 46 and 42 %; these data favor intravenous therapy. However patients in the IMS trial were not equivalent at baseline. They had persistent major vascular occlusions despite early iv tpa treatment and greater clot burden than those in the NINDS trial, and were treated later. This suggests greater benefit in selected patients.