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We thank the authors for their interest in our article.1 We also believe that the combined IV thrombolysis plus stent retriever thrombectomy approach might show a different association between thrombus density and recanalization outcomes than stent retriever thrombectomy alone, which was the focus of our paper. These two distinct groups of patients (thrombectomy with or without preceding administration of IV recombinant tissue plasminogen activator (rtPA)) should be studied separately, as both treatments are now widely applied to modern practice.
We argue that IA administration of rtPA during IA thrombectomy is rather uncommon. For example, early postmarket experience with the Solitaire FR device …
Competing interests Lin, Morr, Natarajan: none. Hopkins: grant/research support-Toshiba; consultant-Abbott, Boston Scientific, Cordis, Covidien; financial interests-AccessClosure, Apama, Augmenix, Axtria, Boston Scientific, Claret Medical Inc., Ellipse, Endomation, Medina Medical, NextPlain, Ostial Corporation, Photolitec, Silk Road, StimSox, ValenTx, Valor Medical; board/trustee/officer position-Claret Medical, Inc.; speakers' bureau-Abbott Vascular, Toshiba; honoraria-Complete Conference Management, Cordis, Covidien, Memorial Healthcare System. Levy: shareholder/ownership interests–Intratech Medical Ltd., Blockade Medical LLC, Medina Medical. Principal investigator: Covidien US SWIFT PRIME Trials. Honoraria for training and lecturing–Covidien. Consultant–Pulsar, Medina Medical, Blockade Medical. Other financial support–Abbott for carotid training for physicians. Mokin: educational grant from Toshiba. Siddiqui: research grants (not related to present work)–National Institutes of Health (co-investigator: NINDS 1R01NS064592-01A1 and NIBIB 5RO1EB002873-07), University at Buffalo (Research Development Award); financial interests–Hotspur, Intratech Medical, StimSox, Valor Medical, Blockade Medical, Lazarus Effect; consultant–Codman & Shurtleff, Inc., Concentric Medical, Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra, Stryker Neurovascular, Pulsar Vascular; speakers' bureaus–Codman & Shurtleff, Genentech; National Steering Committees for Penumbra 3D Separator Trial, Covidien SWIFT PRIME Trial, MicroVention FRED Trial; advisory board–Codman & Shurtleff, Covidien Vascular Therapies; honoraria–Abbott Vascular and Codman & Shurtleff, Inc. for training other neurointerventionists in carotid stenting and for training physicians in endovascular stenting for aneurysms. Snyder: Boston Scientific: Research and stockholder; Cordis: Research and financial interest; EndoTex: Research and financial interest; Medtronic: Research and consultant support; Abbott Vascular: Research and consultant support; ev3: Research and consultant support; Toshiba: Research and consultant support; Micrus: research and consultant support and financial interest; Zimmer: Research and consultant support; Access Closure Inc.: Financial interest and stockholder; Niagara Gore Medical: Stockholder; EPI: Research and financial interest; Primus: Financial interest; Guidant: Research; Kerberos: Research
Provenance and peer review Commissioned; internally peer reviewed.