A very interesting article.....I have thought of doing IAT for such 'distal  MCA' occlusions often but somehow always found noninvasive management better -either IVT  or medical management as indicated...
The problem for me is the smaller infarct volume and relatively preserved clinical status of such patients, at least in my practice, and the complication rate associated with the IAT.
But of course 50+ % success rate is reasonably good....but in our center we have fairly good clinical  outcomes in such patient with IVT...
I am still not impressed in spite of this article...

Is Intra-Arterial Thrombolysis Beneficial for M2 Occlusions? Subgroup Analysis of the PROACT-II Trial [Brief Report]:
Rahme, R et al, Stroke ASAP Dec 2012
Background and Purpose—
The role of endovascular therapy for acute M2 trunk occlusions is debatable. Through a subgroup analysis of Prolyse in Acute Cerebral Thromboembolism-II, we compared outcomes of M2 occlusions in treatment and control arms.
Methods—
Solitary M2 occlusions were identified from the Prolyse in Acute Cerebral Thromboembolism-II database. Primary endpoints were successful angiographic reperfusion (TICI 2–3) at 120 minutes and functional independence (mRS 0–2) at 90 days.
Results—
Forty-four patients with solitary M2 occlusions, 30 in the treatment arm and 14 in the control arm, were identified. Successful reperfusion (TICI 2–3) was achieved in 53.6% and 16.7% of patients in the treatment and control arms, respectively (P=0.04). A favorable clinical outcome (mRS 0–2) was observed in 53.3% and 28.6%, respectively (P=0.19). Baseline characteristics were similar between the 2 groups.
Conclusions—
Intra-arterial thrombolysis may lead to a 3-fold increase in the rate of early reperfusion of solitary M2 occlusions and could potentially double the chance of a favorable functional outcome at 90 days.
Clinical Trial Registration—
This trial was not registered because enrollment began before July 1, 2005.