The review compares recent trials using mechanical endovascular therapies with and without adjuvants to treat acute stroke.The Multi Mechanical Embolus Removal in Cerebral Ischemia trial showed that good revascularization success could be obtained using the Merci retrievers within 8 h of symptom onset. In patients with persistent vascular occlusions despite intravenous tissue plasminogen activator, mechanical embolectomy appeared to be safe. The Interventional Management of Stroke II study achieved similar final revascularization success using low-dose tissue plasminogen activator within 3 h of symptom onset followed by intra-arterial tissue plasminogen activator or EKOS ultrasound plus intra-arterial tissue plasminogen activator. In these trials, patients with recanalization had better outcomes than those without revascularization. Effects of trial design, such as time to treatment, patient age, and use of adjuvant therapies, may affect outcomes.Recent trials of mechanical endovascular therapies have shown recanalization in the majority of target vessels and better outcomes in those patients in whom recanalization was achieved than in those without recanalization. Differences in trial design and lack of head to head comparisons to date make it difficult to determine whether one treatment approach is better than another.