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Here, the safety and efficacy of mechanical thrombectomy after intravenous therapy failure were assessed in 123 patients with acute MCA occlusions. All patients imaged were within 4.5 hours of onset, had DWI ASPECTS greater than 5, and variable NIHSS scores (8–25). The authors found that mechanical thrombectomy after failure of intravenous thrombolysis improves clinical outcomes at 3 months and could represent an alternative in the management of patients with acute MCA occlusion. Additionally, no symptomatic intracranial hemorrhages were detected in patients treated this way, suggesting this protocol is safe.