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Introduction: An evolution in endovascular approaches has been observed in the last decade with stent retrievers (ST) being the latest generation of devices. Stent retriever thrombectomy and manual aspiration (MAT) have each shown to lead to high rates of recanalization as single modality endovascular stroke therapy. We aimed to compare clinical outcomes, efficacy and safety of ‘stent retriever mediated manual aspiration thrombectomy’ and manual aspiration thrombectomy (MAT) alone.Methods: 145 patients with M1 vessel circulation stroke and had undergone thrombectomy treatment were identified between March 2014 and June 2016 in two high volume centers. The patient’s data were retrospectively analyzed to evaluate the technical characteristics, angiographic outcome (Thrombolysis In Cerebral Infarct - TICI score) and clinical outcome at discharge (NIHSS and mRS)Results: 69 patients were treated with ST (Solitaire and Trevo) and 76 with MAT. IV-TPA was administered in 37.4% of cases. Effective recanalization, TICI grades 2b/3, was achieved in 84.1% of cases treated with ST and in 89.5% treated with aspiration with no statistical significance between the two techniques. Symptomatic cerebral hemorrhage was found in 4.3% of the cases. Favorable outcome defined as a mRS of 0-2 at discharge was found in 38% of cases with higher rates in the group treated with ST (56.1% vs 33.3%; p 0.01).Conclusion: Stent retriever mediated manual aspiration thrombectomy is a safe and efficacious method of achieving high revascularization rates for M1 vessel occlusion with improved outcomes at discharge.