PROMISE Registry: PROspective Study on Management of Ischemic Stroke Secondary to mEvo Registry

Inclusion 1. Acute ischemic stroke clinically eligible for immediate EVT 2. Age ≥18 - 85 years of age 3. Time from onset (or last-seen-well) to 24 hours 4. Disabling stroke defined as follows: A. Baseline National Institutes of Health Stroke Scale (NIHSS) score \>5 B. Baseline NIHSS 3-5 with disabling deficit (e.g., hemianopia, aphasia, loss of hand function) as determined and agreed upon by two physicians in context of the patient's life 5. Confirmed treatable MeVO based on neurovascular non-invasive imaging (CTA or MRA), at one or more of the following locations: M2 or M3 segment, A2 or A3 segment, P1, P2 or P3 segment 6. Informed consent: Within the first 72 hours after inclusion in the study 7. ASPECTS ≥5 8. mRS≤2 Exclusion Criteria: 1. Age \>86 2. ASPECTS ≤ 5 3. Any intracranial hemorrhage on initial CT head non contrast 4. mRS≥3 5. Known pregnancy (local protocol to determine if patient is pregnant at the time of stroke) 6. Known severe allergy (more than a rash) to contrast media uncontrolled by medications 7. CT evidence of the following conditions: * Midline shift or herniation * Mass effect with effacement of the ventricles 8. Acute bilateral strokes 9. Contraindication to antiplatelet (aspirin, clopidogrel, ticagrelor, cangrelor) or contrast agents 10. Intracranial tumors other than small meningioma that does not require surgery for one year post randomization. 11. Known hemorrhagic diathesis, coagulation factor deficiency, or on anticoagulant therapy with an International Normalized Ratio (INR) of \>3.0 or Partial Thromboplastin Time (PTT) \>3 times of normal 12. Baseline platelet count \<80,000 per microliter (µl) 13. Life expectancy is less than one year prior to stroke onset14. Participation in another randomized clinical trial that could confound the evaluation of the study outcomes 15\. Any other condition (in the opinion of the site investigator) that precludes an endovascular procedure or poses a significant hazard to the patient if an endovascular procedure was performed