Table 1. Main Clinical Trials of Intra-arterial Thrombolysis before New Era of Endovascular Therapy in Acute Ischemic Stroke.

	PROACT II	IMS III	SYNTHESIS	MR RESCUE
Study period	1996~1998	2006~2012	2008~2012	2004~2011
Subject number	180	656 (early termination)	362	118
Intervention	IA r-proUK plus heparin vs. heparin	EVT plus IV rtPA vs IV rtPA	EVT vs. IV rtPA	EVT vs. standard care
Used devices	Non applicable	Merci, Penumbra, EKOS, Solitaire	Solitaire, Penumbra, Trevo, Merci	Merci, Penumbra
Patients included	Patients with occlusion of MCA <6 h	Patients with IV rtPA <3 h	Patients eligible for IV rtPA (<4.5 h) and EVT (<6 h)	Patients with LAO (anterior circulation) < 8 h
Imaging at baseline	CT	CT, CT angiography	CT	Multimodal CT/MR
Primary endpoint	mRS 0, 1, 2	mRS 0, 1, 2	mRS 0, 1, 2	Shift in mRS
Time to endovascular treatment	5.3 h	249 min (122+127)	3.45 h	> 6 h
Recanalization rate	66% (TIMI 2, 3)	40% (TICI2b/3)	Not reported	27% (TICI2b/3)
Clinical outcome	40% vs. 25% (p=0.04)	40.8% vs. 38.7%	30.4% vs. 34.8%	No difference
Symptomatic ICH	10% vs. 2%	6.2% vs. 5.9%	6% vs. 6%	9% vs. 6% (penumbral pattern)

Abbreviations: EVT, endovascular treatment; MCA, middle cerebral artery; LAO, large artery occlusion; mRS, modified Rankin Scale, ICH, intracerebral hemorrhage

Definition of symptomatic ICH; PROACT, ICH with neurological deterioration within 24 hours; IMS III, neurological worsening within 24 hours; SYNTHESIS, SICH within 7 days; MRRESCUE, 4 or more point worsening of NIHSS (associated with a parenchymal hematoma type 2)