Our aims is to evaluate the equality in efficacy and safety between direct aspiration technique and stent retriever thrombectomy procedure in anterior circulation strokes in a multicenter, prospective study.

Inclusion Criteria:

• Subject experiencing an acute ischemic stroke in which imaging demonstrates a vascular occlusion located in the distal internal carotid artery (ICA) through the distal middle cerebral artery (MCA).
• Subjects in which the aspiration technique is used for at least the first two thrombectomy passes per occluded vessel.
• Subjects older than 18 yo.
• Subjects with a prestroke modified Rankin scale of 0-2 and presenting with an NIHSS of 2-30.
• Subjects that the operator feels may be treated with endovascular therapy
• Subjects in which computed tomography (CT)/Magnetic Resonance Imaging (MRI) demonstrates an infarct size of less than 70cc on MRI or Alberta Stroke Program Early CT (ASPECTS) score overall of 6 or better.
• Subjects in which groin puncture can be obtained within 6 hours of symptom onset (with or without Total Plasminogen Activator administration). In those Patients of more than 8 hours or awake stroke or of unknown onset should be individualized the treatment and must exist area of penumbra in CT perfusion
• Subjects who have consented in accordance with local Institutional Review Board requirements

Exclusion Criteria:

• Absence of large vessel occlusion on neuroimaging.
• Platelet count < 100 x 10³ cells/mm³ or known platelet dysfunction.
• Contraindication to CT and/or MRI (i.e., due to contrast allergy or prior implant that precludes MRI imaging).
• Previously documented contrast allergy that is not amenable to medical treatment.
• Women who are pregnant or breastfeeding at time of intervention.
• Evidence of brain hemorrhage on CT and/or MRI at presenting hospital.

Patients with acute ischemic stroke in which imaging demonstrates a vascular occlusion located in the distal internal carotid artery (ICA) through the distal middle cerebral artery (MCA).