Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: N/A
Brief Summary: Mechanical thrombectomy (TM) is now validated through 4 randomized controlled trials of high scientific level as the reference treatment of cerebral infarction associated with proximal cerebral occlusion (MR CLEAN, ESCAPE 2014, 2015). These studies have shown for the first time a major decrease (-35%) of disability related to severe cerebral infarction and reduction in mortality. These studies only used thrombectomy devices called stent retriever for obtaining recanalization rates ranging from 58-72% for the 2 largest studies (MR CLEAN, ESCAPE 2014, 2015). This criterion "recanalization" is important because it largely determines the functional prognosis of patients with severe cerebral infarction (Khatri, 2014).

These results are exciting but we can do even better. Indeed, already new thrombectomy devices are available with a special interest for ADAPT (A Direct Aspiration First Pass Technic). This distal suction system, with a high level of endovascular navigability, provides high recanalization rates (\> 90%), low morbidity, with a synergistic effect with stent retriever (Turk A, Kowoll 2014 and 2015). To date, these technic (ADAPT) has never been assessed in a randomized controlled trial.

We have previously conducted a comparative observational study between two recanalization strategies by thrombectomy using first-line ADAPT or the most widely used stent retriever. The interventional neuroradiologist could, in case of recanalization failure with the Solitaire system, used another thrombectomy material left to the operator's choice. 244 consecutive patients on two centers (Rothschild Foundation, and Foch Hospital, France) admitted for a cerebral infarction associated with proximal occlusion were included. This is so far the largest series of patients with ADAPT system. The complete recanalization rate was 84% with ADAPT versus 68% with stent retriever (P = 0.006). Unpublished data, Oral presentation at the European Stroke Organization, April 2015). Our research aims to show that a first line strategy of recanalization by thrombectomy using a distal suction system (ADAPT) is superior that the use of a stent retriever.


Options:
A: Arm Label: ADAPT; Type: EXPERIMENTAL; Interventions: Procedure: direct aspiration procedure | Arm Label: Stent Retriever; Type: ACTIVE_COMPARATOR; Interventions: Procedure: stent retriever procedure | Intervention Type: PROCEDURE; Name: direct aspiration procedure; Assigned to Arm(s): ADAPT | Intervention Type: PROCEDURE; Name: stent retriever procedure; Assigned to Arm(s): Stent Retriever
B: Arm Label: Penumbra System with Separator 3D; Type: EXPERIMENTAL; Interventions: Device: Penumbra System with Separator 3D | Arm Label: Penumbra System alone; Type: ACTIVE_COMPARATOR; Interventions: Device: Penumbra System alone | Intervention Type: DEVICE; Name: Penumbra System with Separator 3D; Assigned to Arm(s): Penumbra System with Separator 3D | Intervention Type: DEVICE; Name: Penumbra System alone; Assigned to Arm(s): Penumbra System alone
C: Arm Label: standard medical therapy; Type: ACTIVE_COMPARATOR; Interventions: Other: standard medical therapy | Arm Label: endovascular + standard medical therapy; Type: EXPERIMENTAL; Interventions: Device: endovascular treatment, Other: standard medical therapy | Intervention Type: DEVICE; Name: endovascular treatment; Assigned to Arm(s): endovascular + standard medical therapy | Intervention Type: OTHER; Name: standard medical therapy; Assigned to Arm(s): endovascular + standard medical therapy, standard medical therapy
D: Arm Label: TICAGRELOR; Type: EXPERIMENTAL; Interventions: Drug: Ticagrelor | Arm Label: TICAGRELOR PLACEBO; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: Ticagrelor; Assigned to Arm(s): TICAGRELOR | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): TICAGRELOR PLACEBO

Answer: A