Pragmatic Ischaemic Stroke Thrombectomy Evaluation

Inclusion Criteria: * Clinical diagnosis of supratentorial acute ischaemic stroke * Male or nonpregnant female ≥18 years of age * Clinically significant neurological deficit and NIHSS score ≥6. * 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 (groin puncture maximum 5.5h after stroke onset). * Occlusion of the main middle cerebral artery (MCA) trunk, MCA bifurcation or intracranial internal carotid artery(carotidT, 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 02) * Expected to be able to be followed up at 3 months Exclusion Criteria: * CT evidence of intracranial haemorrhage, or evidence of extensive established hypodensity on CT. * Clinical history suggestive of subarachnoid haemorrhage even if CT normal. * Known 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 occlusion or basilar artery occlusion * Alternative intracranial pathology potentially responsible for the new symptoms * Medical comorbidities 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