Major hemispheric stroke from large intracranial vessel occlusion may not respond to intravenous thrombolysis and may require a more aggressive endovascular approach. Clinical trials have validated the use of these devices. This chapter discusses currently used mechanical clot disruption devices and what they can achieve. For instance, embolectomy (in combination with intravenous thrombolysis) is highly beneficial for patients with severe stroke from large intracranial vessel occlusion and limited infarcted core. Retrievable stents are the preferred tools to treat the occluded vessel. Endovascular reperfusion should be offered to the right patient: if a patient was doing poorly before a large stroke, a benefit cannot be anticipated even if successful reperfusion is achieved.