General Inclusion Criteria

1. Subject is ≥ 18 years old at inclusion (no upper age limit)

2. Clinical signs consistent with acute ischemic stroke with onset 24h from randomization. In case of unknown time of symptoms onset, time last known well (TLKW) should be ≤ 23h[1] from randomization 

3. NIHSS 0-5 at the time of randomization

4. ASPECT score ≥ 6 on non-contrast CT or DWI-MRI

5. Ischemic Stroke confirmed with cerebral imaging or normal imaging with suspected ischemic stroke 

6. Proved anterior circulation intracranial large vessel occlusion on CTA or MRA (ICA, M1)with or without cervical lesion (Tandem)

7. Patient or patient’s representative has received information about the study and has signed and dated the appropriate Informed Consent Form, or fulfilling the criteria for emergent consent.

8. Anticipated possibility to start the procedure (arterial access) within 60 minutes after randomization

9. Pre stroke mRS ≤ 1

[1]Treatmentshould be initiated within 24 hours of TLKW (maximum 60min from time of randomization to treatment)

General Exclusion Criteria

1. Anticipated impossibility to start the procedure (arterial access) within 60 minutes after randomization 

2. Known absence of vascular access

3. Known contrast or endovascular product life-threatening allergy 

4. Female who is known to be pregnant or lactating at time of admission

5. Patient who presents severe or fatal co-morbidities or Life expectancy under 6 months that will likely prevent improvement or follow-up or that will render the procedure unlikely to benefit the patient.

6. Patient unable to be present or available for follow-up

7. Pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations, e.g. severe dementia

8. Evidence of vessel recanalization prior to randomization

9. Seizures at stroke onset if it makes the diagnosis of stroke doubtful and precludes obtaining an accurate baseline NIHSS assessment.

10. Current participation in another investigational drug study

11. Suspicion of aortic dissection based on medical history, clinical evaluation or/and imaging

12. Major patients under guardianship 

Imaging Exclusion Criteria

1. ASPECT ≤ 5 on NCCT or DWI-MRI

2. Isolated proximal cervical ICA occlusion

3. Evidence of intracranial hemorrhage on CT/MRI 

4. Excessive tortuosity of cervical vessels on CTA/MRA that would likely result in unstable access platform

5. High Suspicion of underlying intracranial stenosis on CTA/MRA/DSA

6. Suspected cerebral vascular disease (e.g. vasculitis) based on medical history and CTA/MRA/DSA

7. Presumed calcified Embolus or Intracranial Stenosis decompensation

8. Intracranial stent implanted in the same vascular territory that would preclude the safe deployment/removal of the stentriever device

9. Occlusions in multiple vascular territories (e.g.: bilateral anterior circulation, or anterior circulation/vertebrobasilar system) as confirmed on CTA/MRA/DSA Significant mass effect with midline shift as confirmed on CT/MRI

10. Significant mass effect with midline shift as confirmed on CT/MRI