In 3 recent randomized controlled trials of intra-arterial treatment of acute 
ischemic stroke - IMS-III, SYNTHESIS and MR RESCUE - intra-arterial treatment 
increased the proportion of patients with recanalization and the treatment 
appeared safe. However, the trials did not show an effect on functional 
recovery, although a substantial effect could not be excluded. The delay between 
onset of symptoms and treatment was long, and stent retrievers were used in only 
a few patients. In our view, a rational and ethical approach would now be to 
treat quickly with IV rtPA and when possible, refer and include in new 
randomized clinical trials that compare intra-arterial treatment with standard 
care, such as MR CLEAN or BASICS in the Netherlands.