Endovascular therapy is an effective alternative for recanalization of major vessel occlusion and has become a reality in the armamentarium of stroke treatment. Site-specific intra-arterial delivery of thrombolytic agents has enabled recanalization of anterior and posterior circulation lesions. Mechanical techniques for clot disruption have resulted in increased vessel recanalization rates and reduced hemorrhage rates concomitant with reduced doses of thrombolytic agents. Improvement in patient selection, refinement in technology, and the incorporation of endovascular teams at stroke centers will drive the utility of these techniques forward. Collaboration among the various healthcare professionals involved in the treatment of this disease will facilitate the paradigm change and the scientific and technical research that will orient clinical decision-making in the future.