Middle cerebral artery M2-segment occlusions represent an important subgroup of patients with acute stroke with large-vessel occlusion. The safety of mechanical thrombectomy in distal occlusions remains unclear. In a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization), the authors compares outcomes in patients with isolated M2 occlusions according treated with contact aspiration (CA) versus stent retriever (SR). There were no significant differences between CA (N=48) and SR (N=31) groups in reperfusion rates, modified Rankin Scale, 24-hour change in National Institutes of Health Stroke Scale, or Alberta Stroke Program Early Computed Tomography score. Safety parameters were similar between the 2 groups except for higher 90-day mortality rate in the CA group (19.6% versus 3.3%; P=0.078). Although more studies indicate similar outcomes for patients treated with SR and CA, further studies are indicated to determine the optimal approach to improve outcomes base on patient and disease characteristics.