Endovascular treatment for acute ischemic stroke has evolved significantly since the approval of intravenous recombinant tissue plasminogen activator (rt-PA) in 2005. Initially, rt-PA was effective for stroke patients within 3 hours of symptom onset, but its limited adaptation rate and low efficacy in cases of major vessel occlusion led to the development of endovascular therapies. The approval of devices such as the Merci Retriever in 2010 and the Penumbra System in 2011 marked a shift towards mechanical thrombectomy. These devices allow for clot retrieval and reperfusion, improving outcomes for patients with acute ischemic stroke. However, three randomized controlled trials published in 2013 found no significant benefit of endovascular treatment over rt-PA or standard care. Despite this, newer stent-like retrievers, such as the Solitaire and Trevo devices, have shown higher reperfusion rates and shorter procedural times. These devices are expected to improve outcomes in future randomized trials. The effectiveness of endovascular treatment remains under investigation, with ongoing research aiming to confirm its benefits. The results of the IMS-III, MR-RESCUE, and SYNTHESIS expansion trials highlighted the importance of rapid reperfusion and accurate imaging to guide treatment decisions. Despite these challenges, the development of next-generation devices is expected to enhance the efficacy of endovascular treatment for acute ischemic stroke. Further research is needed to establish the role of these devices in clinical practice.Endovascular treatment for acute ischemic stroke has evolved significantly since the approval of intravenous recombinant tissue plasminogen activator (rt-PA) in 2005. Initially, rt-PA was effective for stroke patients within 3 hours of symptom onset, but its limited adaptation rate and low efficacy in cases of major vessel occlusion led to the development of endovascular therapies. The approval of devices such as the Merci Retriever in 2010 and the Penumbra System in 2011 marked a shift towards mechanical thrombectomy. These devices allow for clot retrieval and reperfusion, improving outcomes for patients with acute ischemic stroke. However, three randomized controlled trials published in 2013 found no significant benefit of endovascular treatment over rt-PA or standard care. Despite this, newer stent-like retrievers, such as the Solitaire and Trevo devices, have shown higher reperfusion rates and shorter procedural times. These devices are expected to improve outcomes in future randomized trials. The effectiveness of endovascular treatment remains under investigation, with ongoing research aiming to confirm its benefits. The results of the IMS-III, MR-RESCUE, and SYNTHESIS expansion trials highlighted the importance of rapid reperfusion and accurate imaging to guide treatment decisions. Despite these challenges, the development of next-generation devices is expected to enhance the efficacy of endovascular treatment for acute ischemic stroke. Further research is needed to establish the role of these devices in clinical practice.