© Springer-Verlag Berlin Heidelberg 2013. Acute ischemic stroke treatment has evolved significantly over the last 20 years. FDA approval of IV, IA, and mechanical thrombolysis has provided physicians with multiple therapeutic options. Development and usage of new techniques often progress so rapidly they do not allow for large-scale clinic trials in all devices. This requires neuroendovascular interventionalists to remain alert not only to current accepted therapies but also to emerging ones. Acute ischemic stroke currently affects a massive amount of Americans each year, and as the American population gets proportionately older, knowledge of revascularization therapies will only become increasingly important.