Acute ischemic stroke (AIS) is not only one of the worldwide leading causes of disability and mortality but is also a significant burden on health systems. Original experience with intra-arterial thrombolysis (such as with recombinant tissue plasminogen activator (TPA)) as well as the use of first generation endovascular devices as a strategy for recanalization of large arterial occlusions in AIS patients raised concerns about their efficacy. However, recent advances in catheter technology and development of large, easily trackable aspiration thrombectomy catheters as well as latest generations of stent retrievers resulted in earlier and more efficient revascularization of large arterial occlusions and subsequent improved clinical outcomes.