In this engaging video, endovascular neurologist Michael Mullen, MD, examines endovascular therapies for acute ischemic stroke from a historic perspective, beginning with intravenous tissue plasminogen activator (tPA) before delving into combination therapies and the novel catheter-based intra-arterial therapies that are redefining stroke treatment for patients with severely occluded vessels in acute ischemic stroke. In his summary, Dr. Mullen offers the parameters for endovascular thrombectomy and guidance on the point at which to send a patient to a comprehensive stroke center. This video is a companion piece to Acute Stroke Therapies, a video by David K. Kung, MD, also on the Penn Neurosciences channel.