The purpose of this chapter is to introduce physicians to the concept of a combined intravenous/intra-arterial (IA) approach to vascular recanalization. Current experience is limited but the concept is attractive and worthy of further study. To understand the potential advantages of a combined approach, it is helpful to first examine the known advantages and limitations of intravenous and IA delivery of thrombolytic agents. The basic rationale for IA thrombolysis is presented in Chapter 10 . Here we discuss some of the limitations of IA therapy.