Résumé : Recanalization is a powerful predictor of stroke outcome. Intravenous (IV) recombinant tissue plasminogen activator (rt-PA), the gold standard, is associated with a limited recanalization rate which can be improved by intra-arterial thrombolysis or mechanical endovascular therapy (MET) which appears very promising. However, the benefits and safety of MET remain unknown. MET has never been evaluated in a prospective randomized clinical trial against IV rt-PA. Recent retrospective analyses have shown a potential benefit of MET with increased recanalization rates and good clinical outcomes at 3 months. Current therapeutic practices appear to follow technological evolution in the field of MET devices rather than strategies founded on evidence based medicine. All of the devices available on the market are used by different teams without proof of their clinical benefit in acute stroke patients. Main challenges include the validation of MET as a first-line therapy for brain infarction and the identification of target populations which could benefit from this approach.