145 The Neuroradiology Journal 24: 145-151, 2011 www.centauro.it SUMMARY – We investigated the efficacy and safety of the combined use of IV tirofiban and IA urokinase and/or mechanical thrombolysis for treating acute stroke patients. Thirteen, consecutive patients who were treated with IV tirofiban and IA thrombolysis with mechanical and/or local IA urokinase infusion, were evaluated retrospectively. The amount of time before the beginning of treatment, urokinase dose, recanalization rates, and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission, at discharge (National Institute of Health Stroke scale[NIHASS]), and three months after the end of their treatment (modified Rankin Scale scores[mRS]). There were 11 patients with internal carotid or middle cerebral artery occlusion treated within six hours of the onset of symptoms and two patients with basilar artery occlusion treated within 12 hours of their symptom onset. The median NIHSS score on admission was 18. The median amount of time from symptom onset to IV tirofiban infusion was 135 minutes, and the median time from symptom onset to IA therapy was 180 minutes. The median dose of urokinase was 200,000 U. Recanalization (thrombolysis in myocardial infarction grade 2 or 3) was achieved in 11 patients. No procedure-related complications were observed. There was one symptomatic he- morrhage. At discharge, the mean NIHSS score was 6.6 (range, 0- 15). Overall, at the time of the three-month follow-up the functional outcome was favorable (modified Rankin Scale score 0 -2) in eight of 13 (62%) patients. Death at 90 days occurred in two of the 13 (15%) patients. Combined IV tirofiban and IA thrombolysis with mechanical clot disruption seems to be a feasible treatment in acute stroke and may be successful in reestablishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions. Intravenous Glycoprotein IIb/IIIa inhibitor (Tirofiban) Followed by Low-dose Intra-arterial Urokinase and Mechanical Thrombolysis for the Treatment of Stroke YON KWON IHN 1 , JAE HOON SUNG 2 , BUM-SOO KIM 3 1 Department of Radiology, St.Vincent’s Hospital, The Catholic University of Korea; Suwon, Korea 2 Department of Neurosurgery, St.Vincent’s Hospital, The Catholic University of Korea; Suwon, Korea 3 Department of Radiology, Seoul St.Mary’s Hospital, The Catholic University of Korea; Seoul, Korea Key words: platelet glycoprotein GPIIb-IIIa complex, thrombolysis, stroke Introduction Acute ischemic stroke with persistent, large- vessel, intracranial occlusion is increasingly being treated using multimodal endovascular therapy combining pharmacologic and mechani- cal strategies 1 . The concept of combining the ad- vantages of intravenous fibrinolysis with those intra-arterial thrombolysis has been explored in several trials and case series 2,3 . Inhibitors of the Glycoprotein (GP) IIb/IIIa receptor are being used alone or in combination with fibrinolytics to treat patients with cerebral ischemia 2,4,5 . We describe a consecutive series of 13 pa- tients presenting with acute ischemic stroke caused by the occlusion of a major cerebral ves- sel, and treated using a procedure starting with an intravenous bolus of the GP IIb/IIIa inhibi- tor tirofiban (Aggrastat, Merck, Whitehouse Station, NJ), followed by mechanical clot lysis combined with locally delivered urokinase, and continuing with infusion of tirofiban through- out and for 48 hours after the interventional procedures. Paper presented at the XIX Symposium Neuroradiologicum, 2010.