Intra-arterial fibrinolytic therapy played a limited role in the recent endovascular trials but was used as rescue therapy, not initial treatment. In MR CLEAN, the EVT method was at the discretion of operator, with 40 of 233 treated with alternative stent retrievers to Trevo and Solitaire or intra-arterial alteplase. Details are not available, but no patients were treated with intra-arterial alteplase alone. Twenty-four of 233 (10.3%) had treatment with a second modality. Treatment method had no impact on outcomes in this trial.206 In THRACE, an intra-arterial lytic was used to a maximum dose of 0.3 mg/kg and allowed to establish goal reperfusion, only after mechanical thrombectomy was attempted. A mean dose of 8.8 mg was administered in 15 of 141 patients receiving mechanical thrombectomy (11%). There was no effect on outcomes compared with mechanical thrombectomy alone. 3.7.4. Technique (Continued) COR LOE New, Revised, or Unchanged 3.7.5. Blood Pressure Management COR LOE New, Revised, or Unchanged In patients who undergo mechanical thrombectomy, it is reasonable to maintain the BP at 180/105 mmHg during and for 24 hours after the procedure. IIa B-NR New recommendation. In patients who undergo mechanical thrombectomy with successful reperfusion, it might be reasonable to maintain BP at a level <180/105 mmHg. IIb B-NR New recommendation. There are very limited data to guide BP management during and after the procedure in patients who undergo mechanical thrombectomy. RCT data on optimal BP management approaches in this setting are not available. The vast majority of patients enrolled in <6-hour RCTs received IV alteplase, and the trial protocols stipulated management according to local guidelines with BP 180/105 during and for 24 hours after the procedure for these participants. Two trial protocols provided additional recommendations. 