Background and Purpose -To evaluate preliminarily efficacy and safety of intravenous tirofiban combined with mechanical clot disruption and urokinase in patients with stroke attributable to major cerebral artery occlusion. Methods -Eleven consecutive patients with stroke attributable to acute occlusion of a major cerebral artery were treated with an intravenous bolus injection of the platelet glycoprotein IIb/IIIa antagonist tirofiban combined with heparin and by endovascular procedures including mechanical thrombolysis and locally delivered urokinas e. Of the 11 cases, 9 involved angioplasty and 2 only microcatheter and microgui dewire manipulation. Results -There were 7 patients with internal carotid or mi ddle cerebral artery occlusion treated within 6 hours and 4 patients with basila r artery occlusion treated within 12 hours of symptom onset. Median National Ins titutes of Health Stroke Scale (NIHSS)score on admission was 20. After the inter ventional procedure, vessel recanalization was partial (thrombolysis in myocardi al infarction grade flow 2 [TIMI 2]) in 7 patients and absent or insufficient in 4 patients. Twenty-four hours after the procedure, all the patients but 1 impr oved substantially, and on control angiography, the occluded vessel was totally patent (TIMI 3) in 10 of the 11 patients. One patient with partial recanalizatio n did not improve and died 3 months later from pulmonary embolism. Neither a sym ptomatic intracerebral hemorrhage nor systemic bleedings requiring blood transfu sion occurred in any patient. At discharge, median NIHSS score was 2. The 3month outcome was excellent in 8 patients (modified Rankin Scale [mRS] 0 to 1), good in 2 patients (mRS 2), and poor in 1 patient (mRS 6). Conclusions -The combinat ion of intravenous tirofiban with intra-arterial mechanical clot disruption and urokinase may be successful in reopening an occluded major cerebral vessel with out increasing the hemorrhagic risk and with good functional outcome. This strat egy cannot be recommended as the systematic treatment of stroke attributable to major cerebral artery occlusion until tested in a controlled study design. Background and Purpose -To evaluate preliminarily efficacy and safety of intravenous tirofiban combined with mechanical clot disruption and urokinase in patients with stroke attributable to major cerebral artery occlusion. Methods-Eleven consecutive patients with stroke attributable to acute occlusion of a major cerebral artery were treated with an intravenous bolus injection of the platelet glycoprotein IIb / IIIa antagonist tirofiban combined with heparin and by endovascular procedures including mechanical thrombolysis and locally delivered urokinase e. Of the 11 cases, 9 involved angioplasty and 2 only microcatheter and microgui dewire manipulation. Results -There were 7 patients with internal carotid or mi ddle cerebral artery occlusion treated within 6 hours and 4 patients with basilar artery occlusion treated within 12 hours of symptom onset. Median National Ins titutes of Health Stroke Scale (NIHSS) score on admission was 20. After the interventional procedure, vessel recanalizat Thrombolysis in myocardi al infarction grade flow 2 [TIMI 2]) in 7 patients and absent or insufficient in 4 patients. Twenty-four hours after the procedure, all the patients but 1 impr oved substantially, and on control angiography, the occluded vessel was totally patent (TIMI 3) in 10 of the 11 patients. One patient with partial recanalizatio n did not improve and died 3 months later from pulmonary embolism. Neither a sym ptomatic intracerebral hemorrhage nor systemic bleedings requiring blood transfu sion occurred in Any patient. At discharge, median NIHSS score was 2. The 3month outcome was excellent in 8 patients (modified Rankin Scale [mRS] 0 to 1), good in 2 patients (mRS 2), and poor in 1 patient . Conclusions -The combinat ion of intravenous tirofiban with intra-arterial mechanical clot disruption and urokinase may be successful in reopening an occluded major cerebral vessel with out increasing the hemorrhagic risk and with good functional outcome. Thisstrat egy can not be recommended as the systematic treatment of stroke attributable to major cerebral artery occlusion until tested in a controlled study design.