Endovascular treatment for acute ischemic stroke has changed remarkably over the past decade. Beginning with IA thrombolytic administration, endovascular strategies have evolved to include aspiration, self-expanding intracranial stents, and now retrievable stents. With the recent publication of 5 randomized, controlled studies (MR CLEAN, EXTEND-IA, ESCAPE, SWIFT PRIME, and REVASCAT), mechanical thrombectomy, when used in combination with IV tPA, has demonstrated a significant radiographic and clinical benefit over traditional strategies with IV tPA alone. These results have placed endovascular therapy at the forefront of stroke treatment, redefining the standard of care.