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The treatment of stroke caused by intracranial vessel occlusion with intravenous recombinant tissue plasminogen activator (rt-PA) was the only evidence-based treatment option for a long time. Nevertheless the response rate was disappointing in large vessel occlusions. Five studies that evaluated the efficacy of mechanical thrombectomy published in 2015 proved a significant clinical benefit for selected patients suffering from acute ischemic stroke. These results are the basis for extensive technical, institutional, and personal structural changes in the neurovascular field of stroke treatment. This review gives an overview of the current status of mechanical thrombectomy and future expectations and challenges are discussed.