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