With the technological advances in acute stroke care, many more patients with the most severe strokes can receive treatments that can reduce death and disability from the disease. Endovascular intervention with mechanical thrombectomy has been shown to improve functional outcomes in select patients with severe stroke and large artery occlusion in the anterior cerebral circulation. This meta-analysis of the major interventional trials showed that the benefit decreased every hour as time from stroke onset to time of arterial puncture for endovascular therapy, eventually becoming non-beneficial at 7.3 hours after stroke onset. Mechanical thrombectomy is now an evidence-based treatment for acute ischemic stroke with proximal anterior circulation large vessel occlusions if initiated within 6-7 hours of treatment. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Philip Chang and Shyam Prabhakaran.