The key to success is to select patients with salvageable brain tissue at the time of intervention. Besides the time window, this largely depends on the collateral circulation provided to the involved tissue. Diffusion-perfusion weighted MRI and perfusion weighted CT scan are being used to demonstrate viable penumbra around the infarct core. Direct injection of thrombolytics (rTPA) provides recanalisation in 50-60% of cases treated with this technique. This is associated with a 9-10% rate of symptomatic parenchymal haemorrhage. Today, mechanical thrombectomy or thrombaspiration is the first choice of interventional treatment. Stent thrombectomy is capable of providing a recanalisation rate of 80-90% on the TICI scale and good clinical outcome (0-2 on the modified Rankin scale) in 45-60% of patients. Results might be improved applying the bridging technique, that is a combination of iv-thrombolysis and local thrombectomy. Faster and more effective recanalisation as well as reduced usage of thrombolytics results in a lower symptomatic haemorrhage rate (4-10%).