Table 2.

Challenges to the “recanalization hypothesis” and rationale for adjunctive APC.

Recanalization problem	APC solution
No reflow phenomenon due to rethrombosis, migration of emboli, secondary thrombosis of downstream arteries, or microcirculatory occlusion	Antithrombotic activity
Reperfusion injury, hemorrhagic transformation, or cerebral edema,	Vasculoprotective effects on BBB integrity
Neurotoxicity	Neuroprotection
Recanalization occurs too late	Neurogenesis and Angiogenesis

The potential explanations for poor clinical outcome despite reopening of occluded vessels and the beneficial properties of APC that redress each of these pitfalls are summarized.