Intravenous recombinant tissue plasminogen activator (rt-PA) was approved in Japan in 2005, leading to the treatment of over 50,000 patients. However, the low adaptation rate and ineffectiveness in certain cases, particularly in major cerebral artery occlusions, have been significant issues. The introduction of the Merci retriever and Penumbra system in 2010 and 2011, respectively, aimed to address these problems. Despite these advancements, three randomized controlled trials (IMS III, MR RESCUE, and SYNTHESIS expansion) published in 2013 found no significant superiority or non-inferiority of endovascular treatment compared to IV rt-PA or standard care. These trials highlighted the need for improved recanalization rates and shorter treatment times. The development of stent-like retrievers, which offer higher recanalization rates and shorter treatment times, is expected to revolutionize endovascular therapy. Future randomized controlled trials are anticipated to confirm the efficacy of these next-generation devices.Intravenous recombinant tissue plasminogen activator (rt-PA) was approved in Japan in 2005, leading to the treatment of over 50,000 patients. However, the low adaptation rate and ineffectiveness in certain cases, particularly in major cerebral artery occlusions, have been significant issues. The introduction of the Merci retriever and Penumbra system in 2010 and 2011, respectively, aimed to address these problems. Despite these advancements, three randomized controlled trials (IMS III, MR RESCUE, and SYNTHESIS expansion) published in 2013 found no significant superiority or non-inferiority of endovascular treatment compared to IV rt-PA or standard care. These trials highlighted the need for improved recanalization rates and shorter treatment times. The development of stent-like retrievers, which offer higher recanalization rates and shorter treatment times, is expected to revolutionize endovascular therapy. Future randomized controlled trials are anticipated to confirm the efficacy of these next-generation devices.