Inclusion Criteria:  Acute ischemic stroke clinically eligible for immediate EVT Age ≥18 years at the date of randomization Time from onset (or last-seen-well) to randomization <12 hours  Disabling stroke defined as follows:  baseline National Institutes of Health Stroke Scale (NIHSS) score >5 at the time of randomization NIHSS 3-5 with disabling deficit (eg. hemianopia, aphasia, loss of hand function) as determined by the attending physician in context of the patient's life situation Confirmed symptomatic and endovascularly treatable MeVO based on neurovascular non-invasive imaging (mCTA or MRA), at one or more of the following locations: M2 or M3 segment, A2 or A3 segment, P2 or P3 segment1. . Clinical deficit commensurate with MeVO occlusion location  . Signed informed consent, two-physician consent, or deferral of consent where approved  Exclusion Criteria:  ASPECTS < 8 The following depend on the imaging modality of the participating site:  9a. NCCT + mCTA  Well demarcated hypodensity in the majority of the brain parenchyma supplied by the occluded vessel or absence of collaterals in the affected territory on the delayed phases of the mCTA OR 9b. NCCT + (m)CTA + CTP** Lack of core: penumbra mismatch (if the CTP is uninterpretable, e.g., due to motion artifacts, apply exclusion criteria from 9a. If single-phase CTA is performed, score collaterals accordingly. If NCCT + mCTA + CTP are all performed, the core: penumbra mismatch criteria are sufficient for exclusion) OR 9c. MRI Diffusion restriction in the majority of the brain parenchyma supplied by the occluded vessel  if MR perfusion is performed: lack of core:penumbra mismatch 10) Any evidence of intracranial hemorrhage on qualifying imaging 11) Patients living in a nursing home or requiring daily nursing care or assistance with activities of daily living.  12) Patient has a major co-morbid illness, such as severe dementia, advanced cancer, advanced heart failure etc. such that they are unlikely to be able to complete follow-up or they are unlikely to achieve the primary outcome due to the underlying illness (rather than the stroke or its treatment).  13) Pregnancy: female with positive urine or serum beta human chorionic gonadotropin (β-hCG) test 14) Participation in another clinical therapeutic intervention trial