Background and Purpose:This study evaluated the safety and efficacy of aggres sive mechanical clot disruption (AMCD) in acute stroke patients with persisting middle cerebral artery(MCA) or internal carotid artery (ICA) occlusion after thr ombolytic therapy. Methods:Retrospective case series were used from a prospecti vely collected stroke database on consecutive acute ischemic stroke patients tre ated with intra-arterial(IA) thrombolytics and mechanical clot disruption durin g a 5-year interval. Thrombolytic dosage, endovascular techniques,immediate and final recanalization rates, symptomatic hemorrhage,mortality, and outcome were determined. Results:Thirty-two patients received AMCD. Median baseline Nationa l Institutes of Health Stroke Scale (NIHSS) score was 18, and median time to ini tiation of IA treatment was 261 minutes from symptom onset. ICA occlusion was no ted in 16 patients and MCA occlusion in 16 patients: 22 received combined IV/ IA thrombolytics, 3 received IV thrombolytics, 6 receivedIA thrombolytics, and 1 patient received no thrombolytics before AMCD. No immediate periprocedural co mplications were noted. Immediate recanalization was achieved in 38%(50%MCA, 2 5%ICA) and final recanalization in 75%(88%MCA,63%ICA) of patients. Favorable outcome occurred in 19(59%) patients, symptomatic cerebral hemorrhage in 3 (9. 4%)patients, and mortality in 4 (12.5%) patients. Conclusion:AMCD can be perf ormed safely with comparable intracerebral hemorrhage and mortality rates to oth er IA therapies even after use of intravenous thrombolytics in selected patients . Early deployment of this technique leads to immediate recanalization in one th ird of patients. AMCD may potentially shorten the time to flow restoration and i mprove overall recanalization rates achieved with IA therapy. Background and Purpose: This study evaluated the safety and efficacy of aggres sive mechanical clot disruption (AMCD) in acute stroke patients with persisting middle cerebral artery (MCA) or internal carotid artery (ICA) occlusion after thr ombolytic therapy. Methods: Retrospective case series were used from a prospecti vely collected stroke database on consecutive acute ischemic stroke patients treted with intra-arterial (IA) thrombolytics and mechanical clot disruption durin ga 5-year interval. Thrombolytic dosage, endovascular techniques, immediate and final recanalization rates, symptomatic hemorrhage , and outcome were determined by IACD. Median baseline Nationa l Institutes of Health Stroke Scale (NIHSS) score was 18, and median time to iniation of IA treatment was 261 minutes from symptom onset. ICA occlusion was no ted in 16 patients and MCA occlusion in 16 patients: 22 received combined IV / IA thrombolytics, 3 received IV thrombolyt Immediate recanalization was achieved in 38% (50% MCA, 25% ICA) and final recanalization in 75% (88% MCA , 63% ICA) of patients. Premature onset of symptomatic cerebral hemorrhage in 3 (9.4%) patients, and mortality in 4 (12.5%) patients. Conclusion: AMCD can be perf ormed safely with comparable intracerebral hemorrhage and mortality rates to oth er IA therapies even after use of intravenous thrombolytics in selected patients. Early deployment of this technique leads to immediate recanalization in one third ird of patients. AMCD may potentially shorten the time to flow restoration and i mprove overall recanalization rates achieved with IA therapy.