Intra-arterial thrombolysis has been advocated for treatment of acute ischemic stroke and several prognostic factors were identified in these patients. Other endovascular methods aiming to recanalize occluded vessels including balloon angioplasty, stenting and use of mechanical clot retrieving devices were devised. To date, this approach is replaced by a multi-modal reperfusion therapy (MMRT) approach that emphasizes combination of various methods to achieve reperfusion. MMRT includes intra-arterial infusion of thrombolytics and/or antiplatelet agents, mechanical clot disruption and retrieval and balloon angioplasty with stent placement. Recent results suggest that MMRT results in higher chances for both recanalization of the occluded artery and reperfusion of the ischemic tissue.