A Cochrane review included 4 RCTs with a total of 350 subjects with acute ischaemic stroke. Three trials evaluated patients with middle cerebral artery territory and one trial with posterior circulation strokes. The trials tested either intra-arterial urokinase or recombinant pro-urokinase vs. an open control. One trial used guidewire-mediated clot disruption in 39 patients in the intervention group. Most data came from trials that started treatment up to 6 hours after stroke; one small trial started treatment up to a median of 12.5 hours after stroke. The intervention administered up to 6 hours after stroke significantly increased the proportion of patients with favourable outcome (modified Rankin score (mRs) 0 - 2) 3 months after stroke (RR 1.47, 95% CI 1.07 to 2.02; 3 trials, n=310). For very good outcome (mRs 0 – 1), there was also a significant effect in favour of treatment (RR 1.73, 95% CI 1.17 to 2.57; 4 trials, n=350). In the light of National Institute of Health Stroke Score (NIHSS) data at 3 months, there was significant effect in favour of treatment (RR 2.03, 95% CI 1.21 to 3.40; 3 trials, n=334). There was no evidence of an effect on death from all causes in the treatment group during the 3-month follow-up (RR 0.89, 95% CI 0.60 to 1.33; 4 trials, n=350). The intervention significantly increased the risk of symptomatic intracranial haemorrhage within 24 hours of treatment (RR 3.85, 95% CI 0.91 to 16.36; 2 trials, n=202).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison)