Objective To explore the safety and efficacy of emergent angioplasty in the treatment of acute middle cerebral artery atherosclerosis-related occlusion. Methods Retrospective analysis was performed in 210 patients with acute ischemic stroke due to middle cerebral artery occlusion, who underwent arterial thrombectomy and emergent angioplasty in our hospital from May 2013 to August 2018. Demographic information, general information, imaging data, treatment, revascularization (assessed by modified thrombolysis in cerebral infarction[mTICI], mTICI 2b/3 was taken as successful recanalization), prognosis and follow-up results were evaluated. Results According to inclusion criteria, 37 patients with acute occlusion of M1 segment stenosis of the middle cerebral artery, who underwent Gateway balloon dilatation and stent implantation, were included in this study. There were 31 males and 6 females with a mean age of (61.1±11.4) years (range, 35-81 years). Computed tomography perfusion imaging was performed in 25 patients before operation, including 17 (68.0%) patients without core infarct volume, 6 (24.0%) with 1-10 mL core infarct volume and 2 (8.0%) with 11-30 mL core infarct volume. M1 lesion was located in proximal 1/2 in 22 (59.5%) patients and in distal 1/2 in 15 (40.5%) patients. Bridging technique was used in 14 (37.8%) patients and direct thrombectomy was used in 23 (62.2%) patients. Five patients were treated with Gateway balloon dilatation alone and 32 patients with stenting (Apollo, Enterprise, Neuroform, Solitaire), with a 100% technical successful rate. Residual stenosis was less than 30% in 30 (81.1%) patients, and between 30% and 50% in 7(18.9%) patients. mTICI 2b/3 recanalization rate was 100%, including 35 cases (94.6%) of grade 3 recanalization.No vascular perforation occurred. Three patients (8.1%) presented stent reocclusion within 1 week after surgery. One patient (2.7%) had symptomatic hemorrhagic transformation. National Institutes of Health stroke scale (NIHSS) increased by 4 points 24 h postoperatively, and modified Rankin scale was 4 at 3 months after surgery. The rate of vascular restenosis was 34.5% (10/29) during follow-up (3-12 months after surgery). Conclusion In acute occlusion of middle cerebral artery M1 segment stenosis, stent retriever is the first choice with a high recanalization rate. Emergent angioplasty is a safe and effective method to treat residual stenosis. Good prognosis can be achieved 3 months after surgery, but the high rate of vascular restenosis cannot be ignored.