Stroke is a leading cause of disability and death in modern society. Aging population, modern lifestyle, and other contributing factors such as ischemic heart disease, atherosclerosis, unbalanced diet, smoking, and hypertension are among known risk factors. While a steady improvement in recognizing and modifying prevention strategies to battle the epidemic of ischemic stroke has taken place over the last few decades, the past decade has seen a giant leap in the development and implementation of ischemic stroke treatment, in particular large vessel occlusion type. The revolution of acute ischemic stroke treatment in many ways pushed the relatively new field of endovascular neurosurgery, which was heavily dominated by aneurysm treatment. Thus, innovations in imaging techniques—understanding how to locate and accurately assess salvageable brain tissue—and innovations in catheter-based intervention techniques are the two main drivers and prisms through which we describe the newly formed paradigms in this chapter.