Thrombolysis has been used successfully in myocardial infarction for 20 years and has been shown to improve morbidity.  In stroke patients it also works by acting as a plasminogen activator, which helps break up the fibrin rich clots which can cause strokes.  

More recently, endovascular thrombectomy, in addition to intravenous thrombolysis within 4.5 hours (when eligible), has become the recommended line of treatment for acute stroke patients with large artery occlusions, up to 6 hours after symptom onset.

Neither of the combined therapies should prevent the initiation of the other, provided there are no contraindications to proceed. Intracranial vessel occlusion should be diagnosed with non-invasive imaging wherever possible, before considering treatment with endovascular thrombectomy. Patients with radiological signs of large infarcts (using the ASPECTS score), may be unsuitable for thrombectomy.

There can be an increased risk of cerebral haemorrhage with thrombolysis, so contraindications such as severe uncontrolled hypertension, direct thrombin inhibitors, acute intracranial hemorrhage, thrombocytopenia and coagulopathy, must be considered before proceeding. 

Endovascular thrombectomy should be performed by an experienced neurointerventionalist who meets national and/or international requirements.