Intra-arterial Versus Systemic Thrombolysis for Acute Ischemic Stroke

Inclusion Criteria: * Sudden focal neurological deficit attributable to a stroke * Clearly defined time of onset, allowing initiation of intravenous treatment within 3 hours of symptoms onset and intra-arterial treatment within 6 hour of symptoms onset. * Age greater than 18 years Exclusion Criteria: * Disability preceding stroke consistent with a modified Rankin scale score of 2-4 * Coma at onset * Rapidly improving neurological deficit * Seizure at onset * Clinical presentation suggestive of a subarachnoid hemorrhage * Previous history of intracranial hemorrhage * Septic embolism * Arterial puncture at a non compressible site within the previous 7 days * Any traumatic brain injury within the previous 14 days * Surgery of the central nervous system in the previous 3 months * Gastrointestinal hemorrhage or urinary tract hemorrhage within the previous 14 days. * Current therapy with intravenous or subcutaneous heparin to rise the clotting time * Known hereditary or acquired hemorrhagic diathesis, baseline INR greater than 1.5, aPTT more than 1.5 times normal, or baseline platelet count less than 100,000 per cubic millimeter * Baseline blood glucose concentrations below 2.75 mm/L (50 mg/dL). * Known contrast sensitivity. * Women of childbearing potential (unless pregnancy impossible) or known to be breastfeeding. Uncontrolled hypertension defined by a blood pressure greater or equal 185 mmHg systolic or diastolic greater or equal 110 mm Hg in 3 separate occasions at least 10 minutes apart or requiring continuous IV therapy. * Prognosis very poor regardless of therapy; likely to be dead within months. * Unlikely to be available for follow-up (eg, no fixed home address, visitor from overseas). * Any other condition which local investigators feels would pose a significant hazard in terms of risk/benefit to the patient, or if therapies are impracticable. COMPUTED TOMOGRAPHIC (CT) SCAN EXCLUSION CRITERIA * Intracranial tumors except small meningioma * Hemorrhage of any degree * Acute infarction (since this may be an indicator that the time of onset is uncorrected)