This randomized, multicenter, open-label, blinded endpoint trial examines 381 patients with emergent M1 or M2 middle cerebral artery occlusions across 8 comprehensive stroke centers in France. Eligible patients were randomized to undergo thrombectomy via stent retriever or contact aspiration with a large bore catheter as the first intervention. Patients were selected within 6 hours of stroke onset and received IV thrombolysis when appropriate. Operators performed at least 3 attempts at thrombectomy with the assigned technique, if revascularization is not achieved then another procedure could then be used at operator discretion. The primary endpoint was successful revascularization as defined by modified Thrombolysis in Cerebral Infarction score of 2b or 3; there was no significant difference between aspiration and stent retriever groups (85.4% vs 83.1%; OR 1.20; 95% CI, 0.68-2.10; p=0.53). Secondary outcomes were percentage of patients successfully revascularized with first-line treatment, time from arterial puncture to revascularization, 90 day modified Rankin score, change in National Institutes of Health Stroke Scale score at 24 hours, and death due to any cause at 90 days. No significant differences in all endpoints or adverse events were found between the two treatment groups.