Inclusion criteria

  • Clinical diagnosis of supratentorial acute ischaemic stroke
  • Male or non-pregnant female ≥18 years of age
  • Clinically significant neurological deficit and NIHSS score ³6
  • Eligible for IV rtPA according to standard guidelines and able to be commenced on IV treatment <4.5h after symptom onset
  • Enrolment, randomisation and procedure commencement (groin puncture) possible within 90 minutes of the start of IV rtPA treatment (maximum 5.5h after stroke onset)
  • Occlusion of the MCA trunk, MCA bifurcation or intracranial internal carotid artery (carotid-T, M1 or single proximal M2 branch) demonstrated on CTA, MRA, or DSA
  • Interventional device delivery (guide catheter placed beyond aortic arch and angio obtained) can be achieved within 6 hours of onset of the stroke
  • Consent of patient or representative
  • Independent prior to the stroke (estimated mRS 0-2)
  • Expected to be able to be followed up at 3 months

Exclusion criteria

  • CT evidence of ICH, or evidence of extensive established hypodensity on CT
  • Clinical history suggestive of subarachnoid haemorrhage even if CT normal
  • Vascular access contraindications e.g. femoral bypass surgery, tight ipsilateral carotid stenosis, unsuitable proximal vascular anatomy likely to render endovascular catheterisation difficult or impossible
  • Extracranial ICA exclusion or basilar artery occlusion
  • Alternative intracranial pathology potentially responsible for the new symptoms
  • Medical co-morbidities which would preclude safe cerebral vessel catheterisation or which are expected to limit life expectancy to <3 months (eg severe cardiac, renal or hepatic failure, significant coagulopathy, metastatic malignancy)
  • Known allergy to radiological contrast