However, patients with occlusions of large, proximal, intracranial arteries are not typically responsive to IV-tPA, early reperfusion occurs in only 13–50% of patients with occlusions in the ICA terminus and the proximal segment of the middle cerebral artery. Until the end of 2014, the only specific therapy for acute ischemic stroke was IV-tPA up to 4.5 hours after symptom onset. Postoperatively, all patients were transferred to the neurointensive care unit after IA-Tx and noncontrast brain CT scan was routinely performed. This procedure is repeated until the occlusion site open, some patients failed recanalization or to detach the stent device at the occluded site. The stent usually deployed and kept in place about 5 minutes then retrieved with aspiration through the balloon guide device. Mechanical thrombectomy was performed using the Solitaire FR device (ev3/Covidien Vascular Therapies). The diseased segment was catheterized highly selectively with a Marksman (ev3) and Synchro 2 (Boston Scientific, Natick, MA, USA). Multiple runs in multiple views were obtained to look for the site of occlusion. The guidewire was removed, the system was flushed, and flow was checked. The femoral artery was catheterized with an 8-French sheath, and 0.038-inch Terumo guidewire (Somerset, NJ, USA) and a 6-French Cello balloon guide catheter (ev3, Irvine, CA, USA) was introduced to the proximal part of offending occluded artery. Usually right side groins were prepped and draped in a sterile fashion. Procedures were performed under local anesthesia with mild sedation and maintenance of systolic blood pressure below 160 mmHg.
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