 The investigators in the Prolyse in Acute Cerebral Thromboembolism PROACT II study found that intra-arterial thrombolysis IAT with prourokinase within 6 hours after onset of symptoms was beneficial in patients with middle cerebral artery MCA occlusion. Intra-arterial thrombolysis IAT thus is an option for treatment of selected patients who have major stroke of 6 hours duration due to occlusions of the MCA. Recently observational study showed that IAT was more beneficial than intra-venous thrombolysis IVT in the specific group of stroke patients presenting with hyperdense middle cerebral artery sign on CT, even though IAT was started later. 