Background: Thrombectomy improves outcomes for stroke patients with large-vessel occlusion, but its impact has been limited in low- and middle-income countries.

Methods: In 12 public hospitals in Brazil, patients with proximal intracranial occlusion treated within 8 hours of stroke onset were randomly assigned to receive either standard care plus thrombectomy (thrombectomy group) or standard care alone (control group). The primary outcome was the modified Rankin scale score at 90 days.

Results: Of 300 enrolled patients, 221 were randomized (111 to thrombectomy, 110 to control). The trial was stopped early due to efficacy. The odds of a better modified Rankin scale score at 90 days were significantly higher in the thrombectomy group (common odds ratio 2.28, 95% CI, 1.41 to 3.69; P=0.001). 35.1% in the thrombectomy group had a score of 0–2, compared to 20.0% in the control group (difference, 15.1 percentage points). Asymptomatic intracranial hemorrhage occurred in 51.4% of the thrombectomy group and 24.5% in the control group, while symptomatic intracranial hemorrhage occurred in 4.5% of both groups.

Conclusions: In Brazil’s public health system, thrombectomy within 8 hours of stroke onset, combined with standard care, resulted in better functional outcomes at 90 days than standard care alone.