Objective       To investigate the safety and efficacy of Solitaire AB stent endovascular mechanical thrombectomy combined with bridging therapy for progressive ischemic stroke and acute ischemic stroke with higher arterial thrombus burden above the aortic arch.        Methods       One case with progressive ischemic stroke caused by middle cerebral artery (MCA) occlusion and over the thrombectomy time window was treated by Solitaire AB stent thrombectomy and bridging intracranial stenting. The other case with higher arterial thrombus burden from the initial part of internal carotid artery (ICA) to the trunk of MCA was treated by Solitaire AB stent thrombectomy and bridging rt-PA arterial thrombolysis. After operation

the patients in the neurosurgical care unit were administrated with the loading dose of aspirin and clopidogrel for inhibiting platelet aggregation

and low-molecular-weight heparin was applied for anticoagulation. The neutroprotective therapy was given

and the mean arterial pressure (MAP) was controlled between 90 mmHg and 120 mmHg.        Results       The first case had national institutes of health stroke scale (NIHSS) 15

modified Rankin scale (mRS) 4

and modified thrombolysis in cerebral infarction (mTICI) 0 before operation

while mTICI 3 after bridging therapy

NIHSS 0 and mRS 1 in 1 week

and NIHSS 0 and mRS 1 at 90 d after operation. The second case had NIHSS 12

mRS 5 and mTICI 0 before endovascular treatment

and mTICI 2b after bridging therapy

NIHSS 2 and mRS 1 in 1 week

and NIHSS 1 and mRS 1 at 90 d after operation. Two cases had no obvious complications after interventional treatment.        Conclusion       Solitaire AB stent thrombectomy combined with bridging therapy is safe and effective in treating progressive stroke over the thrombectomy time window and acute ischemic stroke with higher thrombus burden on large artery under strict perioperative management.