EnDovascular Therapy Plus Best Medical Treatment (BMT) Versus BMT Alone for MedIum VeSsel Occlusion sTroke

Inclusion Criteria:

• Acute ischemic stroke

• Treatment (arterial puncture) can be initiated 2.1. Within 6 hours of last seen well (LSW) OR 2.2. Within 6 to 24 hours of LSW AND

• CT Criteria: Evidence of a hypoperfusion-hypodensity mismatch (Absence ofhypodensity on the noncontrast CT within ≥ 90% of the area of the hypoperfusedlesion on perfusion CT)

• MRI Criteria: Evidence of a diffusion-hyperintensity mismatch (Absence ofhyperintensity on fluid-attenuated inversion recovery (FLAIR) imaging within ≥ 90%of the area of the diffusion weighted imaging(DWI) lesion)

• Isolated medium vessel occlusion (i.e. an occlusion of the co-/non-dominant M2, theM3/M4 segment of theMCA, the A1/A2/A3 segment of the ACA or the P1/P2/P3 segment ofthe PCA) confirmed by CT or MRIAngiography

• National Institute of Health Stroke Scale (NIHSS) Score of ≥ 4 points or symptomsdeemed clearly disabling by treating physician (i.e. aphasia, hemianopia, etc.)

• Informed Consent as documented by signature or fulfilling the criteria for emergencyconsent/ deferral consent

• Agreement of treating physician to perform endovascular procedure

Exclusion Criteria:

• Acute intracranial haemorrhage

• Patient bedridden or presenting from a nursing home

• In-Hospital Stroke

• Known (serious) sensitivity to radiographic contrast agents, nickel, titanium metalsor their alloys

• Foreseeable difficulties in follow-up due to geographic reasons (e.g. patientsliving abroad)

• Pregnancy or lactating women. A negative pregnancy test before randomisation isrequired for all women with child-bearing potential.

• Known history of arterial tortuosity, pre-existing stent, other arterial diseaseand/or known disease at the arterial access site that would prevent the device fromreaching the target vessel and/or preclude safe recovery after EVT

• Severe comorbidities, which will likely prevent improvement or follow-up

• Radiological confirmed evidence of mass effect or intracranial tumour (except smallmeningioma)

• Radiological confirmed evidence of cerebral vasculitis

• Evidence of vessel recanalization prior to randomisation

• Participation in another interventional trial